Issue: 2006 > June > original article

<i>Helicobacter pylori</i> antibiotic resistance in a Dutch region: trends over time

M.J.R. Janssen, L. Hendrikse, S.Y. de Boer, R. Bosboom, W.A. de Boer, R.J.F. Laheij, J.B.M.J. Jansen


Aim: Most patients treated for <i>H. pylori</i> infection
receive empirical therapy based on epidemiological data
of antibiotic resistance. However, previous European
studies indicate that resistance patterns may be changing. Therefore, the aim of this study was to investigate the prevalence of primary clarithromycin and/or metronidazoleresistant <i>H. pylori</i> strains over a six-year period (1997-2002) in a regional hospital.
Methods: All patients visiting Slingeland Hospital in
Doetinchem, the Netherlands between 1997 and 2002
with a positive <i>H. pylori</i> culture were included in this study. Susceptibility to metronidazole and clarithromycin was determined by disk diffusion.
Results: Of the 1355 patients with an <i>H. pylori</i> positive culture, 1127 did not have a history of <i>H. pylori</i> eradication, 58 did, and for 170 this information was not available. Mean rates of primary resistance to metronidazole and clarithromycin were 14.4% (162/1125) and 1.0% (11/1123), respectively. Primary metronidazole resistance was stable throughout the study period and primary clarithromycin resistance showed a decreasing trend. Patients of foreign descent and from secondary care had a higher chance of harbouring primary metronidazole-resistant <i>H. pylori</i> (adjusted OR (95% CI) 1.75 (1.1 to 2.8), and 1.60 (1.1 to 2.2), respectively). Patients with failed <i>H. pylori</i> eradication had a higher chance of harbouring metronidazole-resistant <i>H. pylori</i> (43 <i>vs</i> 14%, p<0.0001) and clarithromycin-resistant
<i>H. pylori</i> (5.3 <i>vs</i> 1.0%, p=0.004) than untreated patients.
Conclusion: Primary metronidazole resistance is stable
at a low level, while primary clarithromycin resistance is
virtually absent in the eastern part of the Netherlands.
Therefore, triple therapy with a proton pump inhibitor,
clarithromycin and amoxicillin can remain the empirical
treatment of choice in the Netherlands.