Studies of antibiotic resistance in children are small in number; an US network for antibiotic resistance that tracked the national incidence rate of H. pylori and microbial resistance reported 340 clinical H. pylori isolates collected over a period of 4 years that demonstrated a 29% rate of antibiotic resistance to at least one antimicrobial agent and 5% resistant to two or more antimicrobial agents: 25% were resistant to Metronidazole and 12.9% were resistant to Clarithromycin. Only a very small number of cases (0.9%) were resistant to Amoxicillin . However, more recently, the results of a larger prospective multi-center study from Europe on the rate of antibiotic resistance in H. pylori strain in 1233 children have been reported. These patients came mostly from western and southern Europe. Most of the isolates were obtained prior to any treatment, and overall the resistance rate for Clarithromycin was 24%. This increased to 42% in those who had previously received treatment that had failed. The resistance rate to Metronidazole was 25% and higher (35%) in those who received previous failed treatment. Resistance to both antibiotics only occurred at 6.9%; however, this increased to 15.3% in those who received previous failed treatment. Resistance to Amoxicillin was exceptionally low at 0.6%. These results confirm that antibiotic usage in children represents a major risk factor for developing treatment resistance .
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