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J Med Microbiol 55 (2006), 65-68; DOI: 10.1099/jmm.0.46208-0
© 2006 Society for General Microbiology
ISSN 0022-2615

Antibacterial resistance in Helicobacter pylori strains isolated from Bulgarian children and adult patients over 9 years

Lyudmila Boyanova1, Rossen Nikolov2, Elena Lazarova3, Galina Gergova1, Nikolai Katsarov4, Victor Kamburov5, Zoya Spassova2, Sirigan Derejian2, Christo Jelev3, Ivan Mitov1 and Zacharii Krastev2

1 Department of Microbiology, Medical University of Sofia, Zdrave Street 2, 1431 Sofia, Bulgaria

2 Department of Gastroenterology, University Hospital St Ivan Rilski, Sofia, Bulgaria

3 Department of Gastroenterology, University Paediatric Hospital, Sofia, Bulgaria

4 Second Surgery Department of Alexander Hospital, Sofia, Bulgaria

5 Urgent Endoscopy Unit, Emergency Hospital Pirogov, Sofia, Bulgaria

Correspondence
Lyudmila Boyanova
lboyanova{at}hotmail.com or
l.boyanova{at}lycos.com

Received 21 June 2005
Accepted 8 September 2005

The aim of this study was to evaluate the primary, combined and post-treatment antibacterial resistance rates in 1205 Helicobacter pylori strains from non-treated (786 adults, 282 children) and treated (109 adults, 28 children) patients in Bulgaria. Susceptibility was tested by the limited agar dilution method. Overall primary resistance rates to metronidazole, clarithromycin, amoxicillin, tetracycline and both metronidazole and clarithromycin were respectively 15·0, 12·5, 1·5, 3·4 and 4·7 % in children and 25·6, 12·6, 0·8, 5·2 and 4·9 % in adults. Primary metronidazole resistance in adults was more common than in children, but the differences for other agents tested were not significant. Primary resistance rates were in the range of those reported worldwide. There was no significant increase in primary resistance rates from 1996/1999 to 2003/2004; however, clarithromycin resistance rates exhibited a slight tendency to increase. Post-treatment resistance to amoxicillin was detected in 1·6 % of 63 strains. Post-treatment resistance to metronidazole was common (81·6 %) and that to clarithromycin was considerable (36 %). Alarming emergence of strains with triple resistance to amoxicillin, metronidazole and clarithromycin was found in two non-treated and three treated patients. The results motivate a larger and continuing surveillance of H. pylori resistance in Bulgaria and worldwide.

Abbreviations: PPI, proton pump inhibitor.






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