title: Helicobacter pylori resistance to antibiotics in Europe and its relationship to antibiotic consumption.
abstract: OBJECTIVE
  Resistance to antibiotics is the major cause of treatment failure of Helicobacter pylori infection. A study was conducted to assess prospectively the antibacterial resistance rates of H pylori in Europe and to study the link between outpatient antibiotic use and resistance levels in different countries.
  
  
  METHODS
  Primary antibiotic resistance rates of H pylori were determined from April 2008 to June 2009 in 18 European countries. Data on yearly and cumulative use over several years of systemic antibacterial agents in ambulatory care for the period 2001-8 were expressed in Defined Daily Doses (DDD) per 1000 inhabitants per day. The fit of models and the degree of ecological association between antibiotic use and resistance data were assessed using generalised linear mixed models.
  
  
  RESULTS
  Of 2204 patients included, H pylori resistance rates for adults were 17.5% for clarithromycin, 14.1% for levofloxacin and 34.9% for metronidazole, and were significantly higher for clarithromycin and levofloxacin in Western/Central and Southern Europe (>20%) than in Northern European countries (<10%). Model fit improved for each additional year of antibiotic use accumulated, but the best fit was obtained for 2005. A significant association was found between outpatient quinolone use and the proportion of levofloxacin resistance (p=0.0013) and between the use of long-acting macrolides only and clarithromycin resistance (p=0.036).
  
  
  CONCLUSIONS
  In many countries the high rate of clarithromycin resistance no longer allows its empirical use in standard anti-H pylori regimens. The knowledge of outpatient antibiotic consumption may provide a simple tool to predict the susceptibility of H pylori to quinolones and to macrolides and to adapt the treatment strategies.
authors.affiliation: INSERM U853, Bordeaux, France. francis.megraud@chu-bordeaux.fr
authors.forename: Francis
authors.initials: F
authors.lastname: Megraud
authors.forename: Samuel
authors.initials: S
authors.lastname: Coenen
authors.forename: Ann
authors.initials: A
authors.lastname: Versporten
authors.forename: Manfred
authors.initials: M
authors.lastname: Kist
authors.forename: Manuel
authors.initials: M
authors.lastname: Lopez-Brea
authors.forename: Alexander M
authors.initials: AM
authors.lastname: Hirschl
authors.forename: Leif P
authors.initials: LP
authors.lastname: Andersen
authors.forename: Herman
authors.initials: H
authors.lastname: Goossens
authors.forename: Youri
authors.initials: Y
authors.lastname: Glupczynski
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002648:Child; D002675:Child, Preschool; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial / Q000187:drug effects*; D004363:Drug Utilization / Q000706:statistics & numerical data*; D005060:Europe; D005260:Female; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D064704:Levofloxacin; D016014:Linear Models; D016015:Logistic Models; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D015999:Multivariate Analysis; D015242:Ofloxacin / Q000494:pharmacology; D011446:Prospective Studies; D012307:Risk Factors; D011795:Surveys and Questionnaires; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D008795:Metronidazole; D064704:Levofloxacin; D015242:Ofloxacin; D017291:Clarithromycin