<i>Helicobacter pylori</i> resistance to antibiotics in Europe in 2018 and its relationship to antibiotic consumption in the community.

Abstract

Our aim was to prospectively assess the antibiotic resistance rates in <i>Helicobacter pylori</i> strains in Europe in 2018 and to study the link between antibiotic consumption in the community and <i>H. pylori</i> resistance levels in the different countries. The proportion of primary antibiotic resistance cases of <i>H. pylori</i> and their corresponding risk factors were investigated in 24 centres from 18 European countries according to a standardised protocol. Data on antibiotic consumption in the community were collected for the period 2008-2017. The link between antibiotic consumption and resistance data was assessed using generalised linear mixed models. The model with the best fit was selected by means of the Akaike Information Criterion. <i>H. pylori</i> resistance rates for the 1211 adult patients included were 21.4% for clarithromycin, 15.8% for levofloxacin and 38.9% for metronidazole and were significantly higher in Central/Western and Southern than in the Northern European countries.The best model fit was obtained for the Poisson distribution using 2013 consumption data. A significant association was found between <i>H. pylori</i> clarithromycin resistance and consumption in the community of macrolides (p=0.0003) and intermediate-acting macrolides (p=0.005), and between levofloxacin resistance and consumption of quinolones (p=0.0002) and second-generation quinolones (p=0.0003). This study confirms the positive correlation between macrolide and quinolone consumption in the community and corresponding <i>H. pylori</i> resistance in European countries. Hence, <i>H. pylori</i> treatment with clarithromycin and levofloxacin should not be started without susceptibility testing in most European countries.