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Prevalence of resistant Helicobacter pylori isolates in Bulgarian children

LYUDMILA BOYANOVA, RADKA KOUMANOVA^*, GALINA GERGOVA, MARIA POPOVA, IVAN MITOV, YOULIA KOVACHEVA^*, SIRIGAN DEREJIAN, NIKOLAI KATSAROV, ROSSEN NIKOLOV and ZACHARII KRASTEV

Department of Microbiology, Medical University of Sofia, *Department of Gastroenterology, University Paediatric Hospital, Sofia, Executive Drug Agency, Sofia, Department of Gastroenterology, University Hospital ‘‘St. Ivan Rilski’', Sofia and Second Surgery Department of Alexander Hospital, Sofia, Bulgaria

Corresponding author: Dr L. Boyanova (e-mail: lboyanova{at}hotmail.com).

Received 27 Feb. 2002; accepted 16 April 2002.

Abstract

The aim of this study was to assess the primary and combined resistances of Helicobacter pylori isolates obtained from paediatric patients in 2000–2001 to seven antimicrobial agents. Resistance rates of pre-treatment isolates from 115 children were investigated by the limited agar dilution method alone and by the E-test. The cut-off concentrations for resistance were: metronidazole >8 mg/L, clarithromycin and azithromycin >1 mg/L, clindamycin >4 mg/L, amoxicillin >0.5 mg/L, tetracycline >4 mg/L and ciprofloxacin >1 mg/L. Primary resistance rates were: metronidazole 15.8%, clarithromycin 12.4%, azithromycin 14.6%, clindamycin 20.0%, amoxicillin 0%, metronidazole + clarithromycin 4.5%, ciprofloxacin 6.0%, metronidazole + clarithromycin + ciprofloxacin 1.2%, tetracycline 3.1% and metronidazole + ciprofloxacin 1.2%. There were no significant age (1–9 years versus 10–18 years) or gender differences. Prevalence of both macrolide-resistant and intermediately susceptible strains was 21.9% for azithromycin and 15.9% for clarithromycin. Of 18 metronidazole-resistant isolates, 77.8% exhibited a metronidazole MIC 32 mg/L. H. pylori resistance rates to metronidazole, clarithromycin and both agents were relatively low in Bulgarian children. However, resistance was found to all drugs tested except for amoxicillin. The consumption of newer macrolides and tetracyclines could be related to the prevalence of resistance to the corresponding agents. There were no significant differences in primary resistance rates of H. pylori to antimicrobial agents between children and adults except for metronidazole. Multi-drug resistance to newer macrolides, metronidazole and ciprofloxacin in association with a slightly elevated amoxicillin MIC (0.38 mg/L) was detected in one strain.

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