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This Article Full Text (Papers in Press[PDF]) All Versions of this Article: jmm.0.009993-0v1 58/7/930    most recent Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via CrossRef Google Scholar Articles by Boyanova, L. PubMed PubMed Citation Articles by Boyanova, L. Agricola Articles by Boyanova, L.

Prevalence of multidrug-resistant Helicobacter pylori in Bulgaria

Medical University of Sofia

¹ E-mail: l.boyanova{at}hotmail.com

Received February 3, 2009
Accepted March 13, 2009

The aim of the study was to evaluate the presence and prevalence of multidrug antibacterial resistance in H. pylori in 2005-2008. The resistance in 828 untreated adults, 124 treated adults and 105 untreated children was 26.5, 50.8 and 16.2% for metronidazole, 18.4, 45.2 and 19% for clarithromycin, 1, 2.4 and 0% for amoxicillin, 4.4, 10.6, and 1.9% for tetracycline; and 9, 14.5, and 5.8% for ciprofloxacin, respectively. Uncommon triple resistance to the evaluated agents was detected in 1% of the untreated children, 3.5% of the untreated adults and 13.6% of the treated adults. Five H. pylori strains were resistant to amoxicillin, metronidazole and clarithromycin, two of them exhibiting quadruple resistance. Resistance to four of the five antibacterials tested was found in 0.7% of the untreated and 1.8% of the treated adults. The total multidrug resistance in the treated adults (15.4%) was more common than that in the untreated adults (4.2%, P=0.0001) and the untreated children (1%, P=0.0001). The presence of multidrug H. pylori resistance in Bulgaria could be associated with many factors, among them, the slightly increasing national consumption of macrolides, lincosamides and streptogramins, and quinolones since 2000, the significant increase of primary H. pylori clarithromycin resistance, the high tetracycline consumption in 1994-1999 and in single cases, with the use of azithromycin based regimens or reuse of nitroimidazoles. In conclusion, for the first time in a European country during the last five years, H. pylori strains harbouring a worrying quadruple antibacterial resistance were found in treated as well as in untreated patients. H. pylori susceptibility patterns tend to become unpredictable and should be monitored constantly at national and global levels.