
A systematic review and meta-analysis of data from 28 countries shows rising Helicobacter pylori antibiotic resistance in children, an international team of researchers reported last week in BMC Medicine.
The review, led by researchers from Iran's Shahid Beheshti University of Medical Sciences, included 63 studies involving 15,953 children from 28 countries in 5 World Health Organization regions. The European region was the most widely represented area, with 30 studies involving 7,462 children, followed by the Western Pacific region (20 studies, 7,202 children). The average age of study participants was 11.8 years and 59% were female. The studies, published from 2000 to 2023, assessed H pylori resistance rates to clarithromycin, metronidazole, levofloxacin, amoxicillin, and tetracycline.
H pylori affects over half the global population, with a higher incidence in developing countries. Infection is associated with gastritis, peptic ulcers, and gastric cancer. The global prevalence of H pylori in children, in whom the bacterium can contribute to malnutrition and growth issues, is 32.3%. While treatment involves a combination of antibiotics and antisecretory drugs, such as proton pump inhibitors, rising antibiotic resistance has emerged as a leading reason for treatment failure in some parts of the world.
Findings warrant 'urgent attention'
The rate of primary resistance to metronidazole was 35.3%, clarithromycin 32.6%, levofloxacin 13.2%, amoxicillin 4.8%, and tetracycline 1.2%. The rates of secondary resistance, based on information from 115 isolates, were 69.3% for clarithromycin, 45.8% for metronidazole, 36.4% for levofloxacin, and 2.9% for tetracycline. Analysis of time trends found significant increases in resistance from 2000-2005 to 2020-2023, escalating from 1.1% to 16.1% for amoxicillin, 20.4% to 49.5% for clarithromycin, 25.0% to 38.5% for metronidazole, and 2.0% to 2.7% for tetracycline.
The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally.
The highest rate of metronidazole resistance (61.5%) was found in children ages 5 to 10, while the highest rate of clarithromycin resistance (51%) was in children 0 to 5 years.
"The escalating trend of H. pylori antibiotic resistance in children warrants urgent attention globally," the study authors wrote. "National and regional surveillance networks are required for antibiotic stewardship in children infected with H. pylori."