Effective therapeutic regimens in two South Asian countries with high resistance to major Helicobacter pylori antibiotics

Abstract

Background Nepal and Bangladesh have a high prevalence of Helicobacter pylori with high resistance rates to clarithromycin, metronidazole, and levofloxacin. Here, we evaluated the susceptibility and genetic mutations of 5 alternative antibiotics against isolates from both countries to obtain an effective treatment regimen for H. pylori eradication. Methods We used the agar dilution method to determine the minimal inhibitory concentration of 5 alternative antibiotics against 42 strains from Nepal and 56 from Bangladesh and performed whole genome mutation analysis. Results No resistance to furazolidone or rifabutin and a high susceptibility of sitafloxacin (95.2% in Nepal and 98.2% in Bangladesh) were observed. In contrast, resistance to rifaximin (52.4% in Nepal and 64.3% in Bangladesh) was high. Moreover, resistance to garenoxacin was higher in Bangladesh (51.6%) than in Nepal (28.6%, P = 0.041), most likely due to its correlation with levofloxacin resistance ( P = 0.03). Garenoxacin and rifaximin were significantly correlated in Bangladesh ( P = 0.014) and occurred together with all sitafloxacin-resistant strains. Mutations of gyrA could play a significant role in garenoxacin resistance, and double mutations of A87 and D91 were associated with sitafloxacin resistance. Analysis of the rpoB gene demonstrated well-known mutations, such as V657I, and several novel mutations, including I2619V, V2592 L, T2537A, and F2538 L. Conclusions Rifabutin can be cautiously implemented as therapy for H. pylori infection due to its interaction with the tuberculosis endemic in Bangladesh. The high susceptibility of furazolidone and sitafloxacin suggests their possible future application in Nepal and Bangladesh. Electronic supplementary material The online version of this article (10.1186/s13756-019-0482-x) contains supplementary material, which is available to authorized users.

Efficacy of tailored second-line therapy of Helicobacter pylori eradication in patients with clarithromycin-based treatment failure: a multicenter prospective study

“…In our previous study, we compared the efficacy of levofloxacin-based regimens as first-line anti-H. pylori treatments and found a low success rate (78%) [34]. Hence, AFEB therapy might be the preferred regimen in regions where bacterial susceptibility data are not available to avoid increased levofloxacin resistance [35,36]. Furazolidone is an effective drug for H. pylori eradication; it has a low resistance rate against H. pylori and is available in many regions [7].…”

“…Furazolidone is an effective drug for H. pylori eradication; it has a low resistance rate against H. pylori and is available in many regions [7]. According to some studies, furazolidone-based quadruple therapy, which has an 88.2% eradication rate, is an efficacious rescue strategy in patients with a previous eradication therapy failure [35].…”

Review: Treatment of Helicobacter pylori Infection 2019

“…In a study of 100 strains from Nepal and Bangladesh where resistance rates to clarithromycin, metronidazole, and levofloxacin are high, no resistance was seen to furazolidone or rifabutin and a high susceptibility of sitafloxacin (95% in Nepal and 98% in Bangladesh) was observed. 58 A study of 63 strains from the Dominican Republic, conducted by the same investigators to the same standard, revealed no resistance to rifabutin, furazolidone, or sitafloxacin. 59 A study from Italy looked at a 14-day triple therapy regime based on rifabutin for patients who had failed at least two prior eradication regimens and achieved a cure in 71% of the patients.…”

Best Helicobacter pylori Eradication Strategy in the Era of Antibiotic Resistance

“…Fourth-generation fluoroquinolones, such as sitafloxacin and garenoxacin, may overcome the quinolone resistance of H. pylori [ 84 , 85 ]. Among 100 strains with high rates of resistance to clarithromycin, metronidazole, and levofloxacin, >95% are susceptible to sitafloxacin [ 86 ]. The efficacy of sitafloxacin or garenoxacin-containing regimens against gyr A mutation-positive H. pylori should be evaluated.…”