Antibiotic resistance of Helicobacter pylori in pediatric patients — 10 years’ experience

• Published in: European journal of pediatrics Vol. 171; no. 9; pp. 1325 - 1330
• Main Authors: Hojsak, Iva, Kos, Tea, Dumančić, Jelena, Mišak, Zrinjka, Jadrešin, Oleg, Jaklin Kekez, Alemka, Lukić Grlić, Amarela, Kolaček, Sanja
• Format: Journal Article
• Language: English
• Published: Berlin/Heidelberg Springer-Verlag 01.09.2012; Springer; Springer Nature B.V
• Subjects: Adolescent; Age; Amoxicillin; Amoxicillin - pharmacology; Amoxicillin - therapeutic use; Anti-Bacterial Agents - pharmacology; Anti-Bacterial Agents - therapeutic use; Antibiotic resistance; Antibiotics; Azithromycin; Bacterial diseases; Bacterial diseases of the digestive system and abdomen; Biological and medical sciences; Biopsy; Child; Child, Preschool; Children; Clarithromycin; Clarithromycin - pharmacology; Clarithromycin - therapeutic use; Croatia; Data processing; Drug resistance; Drug Resistance, Bacterial; Drug Therapy, Combination; Endoscopy; Evolution; Female; Gastroenterology; Gastroscopy; Gender; General aspects; Helicobacter Infections - drug therapy; Helicobacter Infections - microbiology; Helicobacter Infections - pathology; Helicobacter pylori; Helicobacter pylori - drug effects; Helicobacter pylori - isolation & purification; Histology; Hospitals; Human bacterial diseases; Humans; Infant; Infection; Infections; Infectious diseases; Male; Medical sciences; Medicine; Medicine & Public Health; Metronidazole; Metronidazole - pharmacology; Metronidazole - therapeutic use; Microbial Sensitivity Tests; Original Article; Pediatrics; Population studies; Proton Pump Inhibitors - therapeutic use; Retrospective Studies; Risk factors; Treatment Outcome; Ulcers; Variance analysis; Croatia; Antibiotic resistance; Children; Human; Pediatrics; Spirillales; Spirillaceae; Infection; Resistance; Antibiotic; Experience; Helicobacter pylori; Bacteriosis; Bacteria; Antibacterial agent; Child
• ISSN: 0340-6199; 1432-1076
• DOI: 10.1007/s00431-012-1722-8

The aim of this study was to assess the pattern of evolution of resistance to antibiotics in Helicobacter pylori isolated from children who underwent upper endoscopy with antral biopsy during a 10-year period (2001–2010). We retrospectively analyzed data of all children ( n  = 3,008) who underwent upper endoscopy during the observed period at the Children’s Hospital Zagreb, a university tertiary medical center. We calculated the rate, antibiotic susceptibility and risk factors for the H. pylori infection in our cohort. Antral biopsy was performed in 2,313 (76.89%) patients. Altogether, 382 (16.51%) children had positive biopsy for H. pylori (histology and/or culture). There was no significant difference in the incidence of H. pylori during 10 years of observation ( p  = 0.21). Infected children compared to non-infected group were older ( p  = 0.005), and had more often antral nodularity ( p  < 0.0001), and duodenal ulcer ( p  = 0.002). Altogether, 22.4% of treatment-naïve patients had strains resistant to tested antibiotics: majority to azithromycin (17.9%), followed by clarithromycin (11.9%), metronidazole (10.1%) and amoxicillin (0.6%). In the eradication failure group, 9/11 of children had strains resistant to tested antibiotics, mostly to metronidazole (7/11), followed by azithromycin (3/11) and clarithromycin (1/11). No correlation was found between age or gender and antibiotic resistance ( p  = 0.32, for both). In conclusion, our data strongly support current guidelines which recommend antibiotic susceptibility testing prior to eradication therapy. Based on our results we recommend the use of amoxicillin–metronidazole-based regimen as the first-line therapy in our study population.