The Incidence of Primary Antibiotic Resistance of Helicobacter pylori in Vietnam

Abstract

Goals To determine the susceptibility of Helicobacter pylori strains isolated from a Vietnamese population to 5 antibiotics. Background The incidence of antibiotic resistance in H. pylori infection is increasing worldwide and has become a leading cause for failure of treatment. Antibiotic susceptibility testing is very important to provide optimal regimens in a clinical setting. Study We isolated 103 H. pylori strains from the gastric mucosa of H. pylori-infected patients from 2 areas in Vietnam (Ho Chi Minh and Hanoi) in 2008. Epsilometer test was used to determine the minimum inhibitory concentrations of amoxicillin (AMX), clarithromycin (CLR), metronidazole (MNZ), levofloxacin (LVFX), and tetracycline (TC). Results Among the 103 strains, the resistance rates were 0% (AMX), 33% (CLR), 69.9% (MNZ), 18.4% (LVFX), and 5.8% (TC). The resistant strains showed a high-level of resistance (≥256 μg/mL) to CLR, 23.5% (8/34), and MNZ, 29.1% (21/72). The resistance rate for CLR was significantly higher in Ho Chi Minh than in Hanoi (49% vs. 18.5%, P = 0.001). Resistance to both CLR and MNZ was most commonly observed (24.3%). Two strains (1.9%) were resistant to 4 of the 5 antibiotics. No significant association was observed between antibiotic resistance rates and age, gender, or clinical outcomes of the patients. Conclusions High incidence of resistance to CLR and MNZ suggests that standard triple therapies may not be useful as first-line treatment in Vietnam. Alternative strategies such as bismuth-based quadruple therapies or sequential therapy may be more effective in Vietnam.

Antibiotic treatment forHelicobacter pylori: Is the end coming?

“…Levofloxacin is currently recommended as a second-line H. pylori treatment when first-line therapy containing clarithromycin has failed, although levofloxacin resistance has been predicted to increase in the near future [25] . Levofloxacin resistance rates in Asia differ from region to region with rates of 20.6% in the southeast coastal region of China and 18.4% in Vietnam [39,40] . Fluoroquinolone resistance was noted as 62.3% in Pakistan [60] , while Japan and Malaysia had low resistance rates of 8.2% and 0%, respectively [37,42] .…”

“…Overall, the Eastern Asian region has higher metronidazole resistance rates with 95.4% in the southeast coastal region of China [39] and 71.3% in Japan [37] . In Vietnam, the resistance rate was 69.9% among 103 strains [40] . Unlike the clarithromycin resistance rate, there was a high prevalence of resistance to metronidazole (75.5%) in Malaysia [42] , a 76.8% rate in Iran [54] and a high resistance rate in Africa [43,44] .…”

“…Even with third-line eradication therapy, clarithromycin resistance rates in Japan were reported as 86.4% [37] . Several studies in China have reported increased resistance rates Shanghai [38] , 21.5% resistance in the southeast coastal region [39] , and a relatively high rate of 33% in Vietnam, which is near Southeast China [40] . In Western Asia, resistance to clarithromycin has been reported to be > 10% in Iran and > 20% in Turkey [13] .…”

Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam

“…This issue is of particular relevance with regard to clarithromycin, which can induce virtually a 70% loss of effectiveness in the standard triple therapy (proton pump inhibitor, PPI + clarithromycin + amoxicillin) in patients infected with clarithromycin resistant strains versus susceptible strains [11]. Unfortunately, recent data of H. pylori antibiotic resistance in Vietnam showed that the resistance rate to clarithromycin, the key antibiotic for first-line treatment, was very high, in order of 33-34.2% for primary and 73.7% for secondary resistance in adult patients [12,13], and notably, over 50% in children patients [14].…”

“…Moreover, resistance rate to levofloxacin, the alternative drug after first-line eradication treatment failure with the standard triple or quadruple therapy, is also remarkably high in Vietnam, ranging from 18.4% in 2008 to 35.6% for primary resistance and 63.2% for secondary resistance in 2014, showing a rapid acquisition of resistance to levofloxacin in nearly 5 years [12,13]. The resistance towards these two key antibiotics occurred in a high background level of resistance to metronidazole varying from 69.9% to 76,1% [12,13].…”