Rising Antibiotic Resistance in H pylori Infections Among Children

A recent systematic review and meta-analysis published in BMC Medicine highlights growing antibiotic resistance in Helicobacter pylori (H pylori) infections among children. Led by researchers from Iran's Shahid Beheshti University of Medical Sciences, the study analyzed 63 studies from 28 countries across five World Health Organization (WHO) regions, involving 15,953 children. The findings revealed concerning rates of primary resistance to key antibiotics: metronidazole (35.3%), clarithromycin (32.6%), and levofloxacin (13.2%). Secondary resistance rates were even higher, particularly for clarithromycin (69.3%) and metronidazole (45.8%).¹

The study found that the global prevalence of H pylori in children is 32.3%, with rising antibiotic resistance contributing to treatment failures. Time-trend analysis showed significant increases in resistance rates from 2000-2005 to 2020-2023, especially for clarithromycin and metronidazole. The study emphasizes the urgent need for national and regional surveillance networks to tackle this growing issue and improve antibiotic stewardship in pediatric H pylori infections.¹

According to the CDC’s Yellow Book, H pylori is type of bacteria that lives in the stomach, is very common worldwide, infecting about two-thirds of people, especially in developing countries. Most people don't feel any symptoms, but it can cause stomach problems like ulcers, gastritis (inflammation of the stomach), and increase the risk of stomach cancer. The bacteria are usually spread through contact with contaminated food or water. H. pylori can be diagnosed through tests such as a breath test, stool test, or biopsy. Treatment typically involves a combination of antibiotics and other medications, but rising antibiotic resistance complicates treatment, especially for children. Infected children can face long-term complications like growth issues, malnutrition, and an increased risk of gastric cancer.²

A separate study, published in Frontiers, investigated antibiotic resistance in H pylori in Hainan Province, China. This research found high resistance rates to levofloxacin (37.9%), clarithromycin (40%), and metronidazole (93.6%). The study analyzed 140 H pylori strains from clinical isolates, revealing that only 3.3% of the strains were susceptible to all six antibiotics tested. A quarter of the strains were multidrug-resistant, though no resistance was detected to amoxicillin, tetracycline, or furazolidone.³

The study used the E-test method to determine minimum inhibitory concentrations (MICs) and Sanger sequencing to detect resistance genes. It also compared phenotypic and genotypic resistance using whole genome sequencing (WGS). The genotypic analysis showed near-perfect concordance with phenotypic resistance for clarithromycin and levofloxacin, with Kappa values of .910 and .938, respectively. The research also highlighted that amoxicillin, tetracycline, and furazolidone could be viable empirical treatment options in the region.³

The study in Hainan Province expands on the topic of rising H pylori antibiotic resistance discussed in the Iran study by providing a localized, in-depth analysis of resistance patterns and proposing treatment modifications. Both sources contribute to the concern that antibiotic resistance is affecting effective treatment for H pylori infections, especially in children, who face risks of complications such as growth issues, malnutrition, and gastric cancer. The findings stress the need for better diagnostics, regional surveillance, and alternative treatment strategies, particularly for children, where resistance may lead to higher treatment failure rates.³

References

1. Salahi-Niri, A., Nabavi-Rad, A., Monaghan, T.M. et al. Global prevalence of Helicobacter pylori antibiotic resistance among children in the world health organization regions between 2000 and 2023: a systematic review and meta-analysis. BMC Med 22, 598 (2024). https://doi.org/10.1186/s12916-024-03816-y

2. Connor B. Helicobacter pylori. CDC Yellow Book 2024: Travel-Associated Infections & Diseases. CDC. May 1, 2023. Accessed January 2, 2025. https://wwwnc.cdc.gov/travel/yellowbook/2024/infections-diseases/helicobacter-pylori

3. Lv YT, Li D, Zhang DY, et al. Helicobacter pylori resistance in Hainan Province, China: investigating phenotypes and genotypes through whole-genome sequencing. Front Cell Infect Microbiol. 2024;14:1505166. doi:10.3389/fcimb.2024.1505166.