July 18, 2018
By Will Boggs MD
NEW YORK (Reuters Health) - Antibiotic resistance in Helicobacter pylori is widespread across World Health Organization (WHO) regions, according to a systematic review and meta-analysis.
H. pylori infection, which is associated with gastric and duodenal ulcers and gastric cancer, affects approximately 4.4 billion individuals worldwide. International guidelines recommend eradication, with treatment based on local resistance patterns.
Dr. Evelina Tacconelli from University of Verona, Italy and colleagues assessed the prevalence and 10-year trend of primary and secondary H. pylori resistance to commonly prescribed antibiotics. Their systematic review and meta-analysis of 178 studies, involving 53,583 patients from all WHO regions, was published July 7th online in Gastroenterology.
Prevalence rates of primary and secondary resistance to clarithromycin, metronidazole, and levofloxacin were 15% or more in all WHO regions, except primary clarithromycin resistance in the Americas (10%) and Southeast Asia region (10%) and primary levofloxacin resistance in Europe (11%).
Primary combined resistance to clarithromycin and metronidazole was 19% in the Eastern Mediterranean region but less than 10% in other regions.
Primary resistance to amoxicillin and tetracycline was 10% or less everywhere except in the Eastern Mediterranean region, where amoxicillin resistance was 14%.
From 2006-2008 to 2012-2016, clarithromycin resistance in the Southeast Asia region increased from 13% to 21%, and levofloxacin resistance in the Western Pacific region rose from 12% to 31%.
Antibiotic resistance rates were heterogeneous across countries within the various regions and were generally higher among adults than among children.
There was a significant association between eradication treatment failure and resistance detected before treatment for all antibiotics.
Dr. Steven F. Moss from Brown University, Providence, Rhode Island, who has researched various aspects of H. pylori infection and its treatment, told Reuters Health by email, "There have been very few publications on H. pylori eradication rates in the U.S. in the past 10 years and only one publication of resistance from the U.S., so we have done a lousy job in the U.S. of monitoring how we are doing with H. pylori therapy."
"Resistance is high and rising globally," he said. "This is paralleled by worsening H. pylori eradication rates. There is no end in sight to this depressing trend."
"What we need, especially in the U.S., are regional and national H. pylori antibiotic stewardship programs," Dr. Moss said. "I am afraid this is not seen as much of a priority for funding since the diseases prevented by H. pylori eradication (especially gastric cancer) are not obviously linked temporally to the patient when they first present with H. pylori infection. Gastroenterologists should work with their microbiology colleagues to establish these programs."
"An H. pylori vaccine would circumvent the problem of antibiotic resistance, but very few groups are working on one, despite the many theoretical benefits, largely related to paucity of funding and past slow progress in this field," he added.
Dr. Tacconelli did not respond to a request for comments.
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