Antibiotic Susceptibility of Helicobacter pylori Clinical Isolates in Hamadan, West of Iran

Abstract

A B S T R A C TBackground: Surveillance data on Helicobacter pylori antibiotic susceptibilities are limited in Hamadan, Iran. Since antibiotic resistance is one of the reasons in therapies failure. Objectives: Thus the resistance patterns of H. pylori strains to the antibiotics metronidazole, clarithromycin, amoxicillin and tetracycline were evaluated. Patients and Methods: Gastric biopsy specimens of 153 patients with nonulcer dyspepsia, peptic ulcer dyspepsia, and peptic cancer collected during May 2010 to February of 2011, and were cultured on Brucella agar (Merck, Germany) under microaerophilic conditions. H. pylori isolates were identified using standard biochemical test. Eighty three (54.2 %) specimens had positive results by culture. Antimicrobial susceptibility testing was performed by disc diffusion method. Results: Totally in vitro resistance rates were 63.8% for metronidazole, 26.5% for clarithromycin, and 7.2% for amoxicillin. Although, 25.3% of strains showed resistance to two antibiotics, and 3.6% to three antibiotics. Tetracycline resistance was identified in only two isolates. Fifty nine percent of the clarithromycin resistant strains also showed resistance to metronidazole. No gender and age associations with resistance were detected. Conclusion: Our results showed a high incidence of metronidazole resistance (often combined with clarithromycin-resistance) in the isolates. Continuous surveillance is recommended to examine the treatment strategies for H. pylori eradication.

Antimicrobial Resistance Profile of Helicobacter pylori Clinical Isolates in Duhok City, Kurdistan Region/Iraq

“…Resistance to drug combination was found among studied isolates in which 3.3% of isolates were resistant to four combined drugs, 3.3% to three combined drugs and variable resistant patterns to two combined drugs (Table 2). High rate of resistance (51.3%) was found to metronidazole which was comparable to that recorded by [13,14,15] who found that 57.5%, 51.5% and 56.3% of H. pylori isolates from Iranian patients were resistance to metronidazole respectively and Mansour et al, [16] found that 56.8% of the H. pylori isolates from Tunisian patients were resistance to metronidazole, but much lower than those found by Aboderin et al, [17] who found that 100% of H. pylori isolates from Nigerian patients were resistance to metronidazole and Majlesi et al, [18] who found 63.8% of H. pylori isolates from Iran were resistance to metronidazole. This high rate of resistance to metronidazole may be due to the wide use of this drug for other infections such as dental, gynecological and parasitic infections [19,20].…”

“…This high rate of resistance to metronidazole may be due to the wide use of this drug for other infections such as dental, gynecological and parasitic infections [19,20]. Resistance to clarithromycin was 10% which is lower than those recorded in other part of the world such as Mohammedi et al, [13], Mirzaei et al, [15] and Majlesi et al, [18] who found that 26.5%, 16.7% and 14.6% of the H. pylori isolates from Iranian patients were resistance to clarithromycin respectively, Mansour et al, (2010) from Tunisia found 15.4% were resistance and Aboderin et al, [17] from Nigeria found 100% were resistance. Resistance to clarithromycin can be developed either by using this drug as a key component of the drug combination used against H. pylori or used for the treatment of respiratory tract infection or due to the previous consumption of macrolides which induce cross resistance to clarithromycin [21].…”

Helicobacter pylorieradication in West Asia: A review

“…In Iran, Clarithromycin resistance has increased from 1.4% in 1997 [13] to 26.5% in 2013 [14] . The rate is even reported higher in Turkey and Bahrain [15][16][17] .…”

“…In Iran, the resistance rate has been increasing, from 33% in 1997 to 76.8% in 2012 [13,14,[41][42][43][44]58] . The rate has also been rising from 38% to 78.5% over the past 20 years in Saudi Arabia [59][60][61][62] .…”

“…But when administering higher doses, some studies have reported optimal results even in case of high resistance to Metronidazole. Luther et al [66] reported 97.1% PP eradication rate with 2 wk of Omeprazole (20 mg BD), Bismuth sub- Iran [13] 1997-2000 70 DDM 1.4 33% 0% 1.4% Iran [14] 2001-2004 135 DDM 3.7 36.3% 0.7% 3.7% Iran [42] 2005 120 DDM 1.6 57.5% 0% 16.7% Iran [58] 2005 [110] 2013 153 DDM 7.2 63.8% -26.5% -Turkey [45] 2003 87 DDM ---27.5% Turkey [16] 2004 110 DDM ---48.2% Turkey [17] 2006 92 DDM ---40.5% Turkey [111] 2007 61 DDM ---16.4% Turkey [63] 2012 61 DDM 0 42.6% 0% 21.3% Levofloxain: 3.3% Lebanon [112] 2002 54 DDM 0 29.5% 2% 4% Bahrain [15] 1999 83 Epsilometer test -57% -33% Saudi Arabia [59,61] 1988 71 DDM -38% 1.4% -Saudi Arabia [59,61] 1996 62 DDM -85.5% 0% -Saudi Arabia [59] 1998 63 DDM -78.5% --Saudi Arabia [60] 2002 223 DDM 1.3 80% 0.4% 4% Saudi Arabia [62] 2008 46 DDM 0 69.5% -21% UAE [113] 2010 26 E-test ---19.2% UAE [64] 2013 16 ? -63% --Syria [114] 2012 ously during the entire duration of therapy.…”