Antibiotics may have saved millions of lives since 1928 with the birth of penicillin by Sir Alexander Fleming but, decades later, bacterial infections once again are posing a threat with the emergence of mutated pathogens, "superbugs."

This antibiotic resistance crisis we find ourselves in is attributed to the overuse and misuse of these medications, as well as stagnation in drug development by the pharmaceutical industry due to lowered economic incentives and challenging regulatory requirements. Antibiotic resistance occurs upon meeting with medications designed to eliminate or stop their growth.

The pressure in the hunt for new antibiotics is higher than ever as a new study reveals that resistance to commonly-used antibiotics in the treatment of harmful bacteria associated with several stomach conditions has more than doubled over the past two decades.

An analysis involving 1,232 patients from 18 countries across Europe looked into resistance against the antibiotics frequently used to treat Helicobacter pylori (H. pylori) infections. This bacteria is typically responsible for gastric ulcer, lymphoma, and gastric cancer.

"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."

Clarithromycin, a go-to antibiotic for H. pylori infection, incurred a resistance rate of 21.6 percent last year, up from 9.9 percent in 1998. Resistance to levofloxacin and metronidazole is also on the rise.

Lead researcher Professor Francis Megraud, explained, "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 percent 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."

H. pylori is amongst the most prevalent bacterial infections in humans. This bacteria is also present in approximately half of the world’s population. To underline the gravity of the situation, the World Health Organization (WHO) declared clarithromycin-resistant H. pylori a high priority bacterium for antibiotic research and development.

The rate of 'primary' clarithromycin resistance in H. pylori in Europe in 2018 (%) found in the study was:

  • Southern Italy: 36.9
  • Croatia: 34.6
  • Greece: 30.0
  • Poland: 28.5
  • Bulgaria: 26.9
  • Ireland: 25.6
  • Austria: 23.5
  • France: 22.5
  • Germany: 22.2
  • Portugal: 20.0
  • Belgium: 17.4
  • Spain: 17.1
  • Slovenia: 16.0
  • Lithuania: 13.0
  • Netherlands: 9.2
  • Norway: 8.9
  • Latvia: 6.8
  • Denmark: 5.0
H. pylori bacterium have "tails" that allow them to swim through the protective layer of gastric mucus in the stomach and attach to the cell layer beneath, where it can cause inflammation over the course of lifelong infection. Image by Arek Socha from Pixabay