{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,12,18]],"date-time":"2025-12-18T09:30:34Z","timestamp":1766050234060,"version":"3.40.5"},"reference-count":26,"publisher":"Akademiai Kiado Zrt.","issue":"1","funder":[{"name":"Medical University of Sofia","award":["D-129\/14.06.2022"],"award-info":[{"award-number":["D-129\/14.06.2022"]}]}],"content-domain":{"domain":["akjournals.com"],"crossmark-restriction":true},"short-container-title":["AMicr"],"published-print":{"date-parts":[[2023,3,2]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p xml:lang=\"en\">Prevalence of antibiotic resistant <jats:italic>Helicobacter pylori<\/jats:italic> was compared between 50 patients living outside the capital city and 50 matched pairs of capital city residents (CCRs). <jats:italic>H. pylori<\/jats:italic> isolates from 2018 to 2022 were included. Resistance rates in CCRs and those living elsewhere were 4.0 and 6.0% to\u00a0amoxicillin, 48.0 and 42.0% to metronidazole, 30 and 30% to clarithromycin, and 4.0 and 4.0% to tetracycline, respectively. Levofloxacin resistance was higher (38.0%) in the capital city vs 20.0% (<jats:italic>P<\/jats:italic>\u00a0=\u00a00.047) in the country. Odd ratio for levofloxacin resistance between pair-matched groups was 2.45 (95% CI, OR 1.0\u20136.02, <jats:italic>P<\/jats:italic> value = 0.05) and relative risk for fluoroquinolone resistance was 1.90 (95% CI for RR 0.98\u20133.67) for CCRs vs residents in other regions. Resistance rates to levofloxacin and clarithromycin were worryingly high in our study, most probably due to the high quinolone consumption (2.86 DDD\/day in 2017) in Bulgaria and the increase in macrolide, lincosamide and streptogramin consumption, especially of azithromycin, by &gt;42% with the start of COVID-19 pandemic. Briefly, antibiotic resistance of <jats:italic>H. pylori<\/jats:italic> has a dynamic change, and it can display different patterns in certain geographic regions. The results imply that antibiotic consumption should be carefully controlled and unjustified use of levofloxacin should be restricted, especially in some large cities. Antibiotic policy should be further strengthened and regular monitoring of resistance in various geographic regions is needed for treatment optimization.<\/jats:p>","DOI":"10.1556\/030.2023.01940","type":"journal-article","created":{"date-parts":[[2023,1,13]],"date-time":"2023-01-13T19:13:11Z","timestamp":1673637191000},"page":"79-83","update-policy":"https:\/\/doi.org\/10.1556\/policypage.crossmark.crossref.2","source":"Crossref","is-referenced-by-count":6,"title":["Geographic distribution of antibiotic resistance of Helicobacter pylori: A study in Bulgaria"],"prefix":"10.1556","volume":"70","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-9622-0873","authenticated-orcid":true,"given":"Lyudmila","family":"Boyanova","sequence":"first","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Galina","family":"Gergova","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Nayden","family":"Kandilarov","sequence":"additional","affiliation":[{"name":"Department of General and Hepatobiliary Pancreatic Surgery, Department of Surgery, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Liliya","family":"Boyanova","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Daniel","family":"Yordanov","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Raina","family":"Gergova","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Rumyana","family":"Markovska","sequence":"additional","affiliation":[{"name":"Department of Medical Microbiology, Medical Faculty, Medical University of Sofia, Sofia, Bulgaria"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"425","reference":[{"issue":"25","key":"B1","series-title":"Dtsch Arztebl Int","first-page":"429","article-title":"Helicobacter pylori infection","volume":"115","author":"Fischbach W","year":"2018","unstructured":"Fischbach W, Malfertheiner P. Helicobacter pylori infection. Dtsch Arztebl Int 2018; 115(25): 429\u2013436. https:\/\/doi.org\/10.3238\/arztebl.2018.0429."},{"issue":"6","key":"B2","series-title":"J Microbiol Immunol Infect","first-page":"1184","article-title":"Multidrug resistance: the clinical dilemma of refractory Helicobacter pylori infection","volume":"54","author":"Kuo CJ","year":"2021","unstructured":"Kuo CJ, Lee CH, Chang ML, Lin CY, Lin WR, Su MY, et\u00a0al. Multidrug resistance: the clinical dilemma of refractory Helicobacter pylori infection. J Microbiol Immunol Infect 2021; 54(6): 1184\u20131187. https:\/\/doi.org\/10.1016\/j.jmii.2021.03.006."},{"key":"B3","series-title":"Front Mol Biosci","first-page":"19","article-title":"Mechanisms of Helicobacter pylori antibiotic resistance and molecular testing","volume":"1","author":"Nishizawa T","year":"2014","unstructured":"Nishizawa T, Suzuki H. Mechanisms of Helicobacter pylori antibiotic resistance and molecular testing. 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