Antibiotic-Resistant H Pylori is on the Rise in Europe

Resistance to antibiotics commonly used to treat Helicobacter pylori (H pylori) infection has more than doubled in Europe during the past 20 years, according to new research.

The study, presented at UEG Week Barcelona 2019, analyzed 1232 patients from 18 countries and found increases in resistance to clarithromycin, levofloxacin, and metronidazole between 1998 and 2018.

Resistance to clarithromycin saw the sharpest increase, rising to 21.6% last year, up from 9.9% in 1998. Lead investigator Francis Megraud, MD, professor of bacteriology at University of Bordeaux, and founder and current secretary of the European Helicobacter & Microbiota Study Group, told Contagion^® that the results weren’t surprising because they follow a trend.

“H pylori resistance to clarithromycin is slowly increasing during the last 20 years in Europe. It is over the threshold defined to test it before to prescribe it (15%) except in Northern countries,” Megraud told Contagion^®.

The rate was highest in southern Italy at 36.9%, Croatia at 34.6%, Greece at 30%, Poland at 28.5% and Bulgaria at 26.9%. It was lowest in Denmark at 5%, Latvia at 6.8%, Norway at 8.9%, the Netherlands at 9.2% and Lithuania at 13%.

Rates of resistance to levofloxacin rose from 14.1% in 2008 to 16.3% in 2018, and for metronidazole, the resistance rates were 33.1% in 1998, 34.9% in 2008 and 39.1% in 2018.

The high rates of resistance in some countries may reflect overconsumption of antibiotics and lack of support for programs aimed at curbing resistance. Investigators will work to correlate the study data with data of antibiotic consumption in different European countries, Megraud said.

“When it is not possible to test the patient H pylori strain, it is important to have some knowledge on the global resistance in the country or area especially for clarithromycin and levofloxacin,” Megraud told Contagion^®.

The increase in antibiotic resistance raises concerns that treatment options will become increasingly limited and ineffective if new therapies aren’t developed and that the incidence of associated conditions such as gastric cancer and peptic ulcer disease will remain high, Megraud said in a press release.

Antibiotic resistance is one of the biggest threats to global health. Infections from resistant bacteria cause more than 750,000 deaths each year, a number that is expected to rise dramatically unless urgent action is taken, according to the news release.

Clarithromycin-resistant H pylori is among a list of pathogens recognized by the World Health Organization as a priority for novel antibiotic research and development. The Multi-Drug Resistant Organism Network, a global research network, aims to provide an infrastructure of sites working to tackle antimicrobial resistance.

Antimicrobial stewardship programs worldwide aim to limit unnecessary exposure to antibiotics. One focus is to eliminate unnecessary antibiotic treatment of noninfectious conditions.

Meanwhile, work to develop novel treatments for antimicrobial-resistant infections continues.

In July, the US Food and Drug Administration granted Priority Review designation to RedHill Biopharma Ltd.'s New Drug Application for RHB-105 (Talicia) for the treatment of H pylori infection with a Target Prescription Drug User Act (PDUFA) action date of November 2, 2019.