Risk factors for primary Helicobacter pylori resistance in Bulgarian children

Area of Science:

• Pediatric infectious diseases
• Microbiology
• Gastroenterology

Background:

• Helicobacter pylori infection is a common cause of gastroduodenal diseases in children.
• Antibiotic resistance in H. pylori poses a significant challenge for effective treatment.
• Understanding primary resistance patterns is crucial for guiding empirical therapy.

Purpose of the Study:

• To investigate the prevalence and risk factors of primary antibiotic resistance in pediatric H. pylori infections.
• To assess resistance rates to metronidazole, clarithromycin, tetracycline, and amoxycillin.
• To identify potential associations between resistance and demographic factors like age, sex, and place of residence.

Main Methods:

• A study of 186 children with gastroduodenal diseases was conducted between 2000-2003.
• Antibiotic susceptibility testing was performed using a limited agar dilution method.
• Data on patient demographics and place of residence were collected.

Main Results:

• Overall resistance rates were 14.5% for metronidazole, 11.9% for clarithromycin, and 3.3% for tetracycline; no amoxycillin resistance was observed.
• Clarithromycin resistance was significantly higher in children from small towns/villages (22.7%) compared to large towns/cities (8.5%).
• Children aged 1-7 years exhibited low resistance rates, with no combined resistance to metronidazole and clarithromycin.

Conclusions:

• Primary H. pylori resistance in children in this cohort was generally low, particularly in younger age groups.
• Place of residence emerged as a significant factor associated with clarithromycin resistance.
• These findings highlight the need for regional surveillance of antibiotic resistance patterns in pediatric H. pylori infections.