Researchers have uncovered a worrisome trend in which harmful bacteria known to cause dangerous stomach diseases are becoming increasingly resistant to even some of the most powerful antibiotics at our disposal. According to a new study, resistance to commonly-used antibiotics has doubled in the past 20 years.

For their study, the team led by Francis Megraud, Professor of Bacteriology at the University of Bordeaux in France and the founder of the European Helicobacter & Microbiota Study Group, studied the antibiotic response of 1,232 patients from 18 countries who were infected with Helicobacter pylori (H. pylori).

If left untreated, this bacterial infection may cause gastric ulcers, lymphoma, and even gastric cancer.

For years, doctors have been prescribing clarithromycin to ward off H. pylori, but since 1998, resistance to the antibiotic has surged from 9.9% to 21.6% as of last year. The researchers found similar jumps in resistance for levofloxacin and metronidazole.

“H. pylori infection is already a complex condition to treat, requiring a combination of medications. With resistance rates to commonly used antibiotics such as clarithromycin increasing at an alarming rate of nearly 1% per year, treatment options for H. pylori will become progressively limited and ineffective if novel treatment strategies remain undeveloped. The reduced efficacy of current therapies could maintain the high incidence rates of gastric cancer and other conditions such as peptic ulcer disease, if drug resistance continues to increase at this pace,” Megraud said in a statement.

The study found that the highest rates of clarithromycin resistance in H. pylori were in Southern Italy (39.9%), Croatia (34.6) and Greece (30%). It’s no wonder that these countries are also known for overconsumption of antibiotics in inappropriate situations, including for conditions like cold and flu (for which antibiotics are useless since they’re caused by viral infections). These countries also have poor antibiotic resistance containment strategies.

Antibiotic resistance occurs when an antibiotic is no longer effective at controlling or killing bacterial growth. Bacteria that are ‘resistant’ can multiply in the presence of various therapeutic levels of an antibiotic. Sometimes, increasing the dose of an antibiotic can help tackle a more severe infection but in some instances — and these are becoming more and more frequent — no dose seems to control bacterial growth. Each year, 25,000 patients from the EU and 63,000 patients from the USA die because of hospital-acquired bacterial infections which are resistant to multidrug-action. 

According to a 2013 CDC report titled “Antibiotic Resistance Threats in the United States“, antibiotic resistance is responsible for $20 billion in direct health-care costs in the United States. Without urgent action, the number of infections could rise dramatically.

H. pylori is believed to be present in about one half of the world’s population, but most never get sick. Some, however, aren’t so lucky and the bacteria can cause some uncomfortable complications like inflammation of the stomach lining (gastritis) and peptic ulcers.

For some time, H. pylori antibiotic resistance has been considered as a severe threat to public health, with the World Health Organization (WHO) calling clarithromycin-resistant H. pylori a high priority for antibiotic research and development. According to an OECD report, superbug infections could cost the lives of around 2.4 million people in Europe, North America and Australia over the next 30 years. The good news is three out of four deaths could be averted by spending just 2 USD per person a year on measures like handwashing and more prudent prescription of antibiotics.

“The findings of this study are certainly concerning, as H. pylori is the main cause of peptic disease and gastric cancer,” commented Mário Dinis-Ribeiro, President of the European Society of Gastrointestinal Endoscopy. “The increasing resistance of H. pylori to a number of commonly-used antibiotics may jeopardize prevention strategies.”

The findings appeared in the journal UEG Journal and were presented today at UEG Week Barcelona 2019.