Determination of Antibiotic Sensitivity Pattern of Helicobacter pylori Isolates from South India Population

Khawaja Shakeel Ahmed, Anghesom Ambesajir Ghebremedhin, Aleem Ahmed Khan, Santosh K. Tiwari, J. D. Ahi, Irshad Ahmed

Asmara College of Health Sciences, Department of Clinical Laboratory Sciences, Microbiology Unit, Asmara, Eritrea.
Centre for Liver Research and Diagnostics, Hyderabad, India.
Dr. Hari Singh Gour University, Sagar, India.

DOI: 10.4236/aim.2012.23031                

Abstract

Introduction: The importance of H. pylori as an etiological agent in gastroduodenal disease had suggested antibiotic treatment as a main target for the elimination of infection. The successful eradication of H. pylori infection was shown to resolve the gastritis, dramatically accelerate ulcer healing, reduce ulcer recurrence and the prophylactic effect on the recurrence of ulcer bleeding. Materials and Methods: In the present study a total six antimicrobial agents such as Ciprofloxacin, Metronidazole, Norfloxacin, Tetracyclin, Amoxycillin and Clarithromycin were used against 100 clinical isolates from patients with peptic ulcer, and non-ulcer dyspepsia. H. pylori was isolated from the gastric biopsies obtained from the clinical subjects. Results: Results of our study showed 100% resistance to Metronidazole (MIC > 256 μg/ml). 97% of the isolates were observed sensitive to Ciprofloxacin (MIC 0.38 μg), whereas Tetracyclin showed 96% sensitivity (MIC 0.25 μg - 0.125 μg). Resistance to amoxycillin, Norfloxacin, and Clarithromycin were 80%, 38% and 76% respectively (MIC > 256 μg/ml). Conclusion: It is observed that 96% - 97% of the clinical isolates were sensitive to Tetracycline and ciprofloxacin, where all isolates were found to be resistant to Metronidazole. Resistance to Amoxycillin and Clarithromycin were 80% and 76% respectively. Studies attributed the high level of resistance to the frequent use of the drugs to treat various other infections and ineffective drug control policy.

Keywords

Helicobacter pylori; Culture; Metronidazole; Tetracycline; Clarithromycin

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. D. Penston, “Review Article: Helicobacter pylori Eradication under Standable Caution but No Excuse for Inertia,” Alimentary Pharmacology and Therapeutics, Vol. 8, No. 4, 1994, pp. 369-389. doi:10.1111/j.1365-2036.1994.tb00304.x
[2]	R. J. Laheij, L. G. Rossum, J. B. Jansen, H. Straatman and A. L. Verbeek, “Evaluation of Treatment Regimens to Cure Helicobacter pylori Infection—A Meta-Analysis,” Alimentary Pharmacology and Therapeutics, Vol. 13, No. 7, 1999, pp. 857-864. doi:10.1046/j.1365-2036.1999.00542.x
[3]	F. Mégraud, “Problems Caused by Antibiotic Resistance of Helicobacter pylori,” La Presse Médicale, Vol. 26, No. 37, 1997, pp. 1775-1780.
[4]	D. Y. Graham, “Antibiotic Resistance in Helicobacter pylori: Implications for Therapy,” Gastroenterology, Vol. 115, No. 5, 1998, pp. 1272-1277. doi:10.1016/S0016-5085(98)70100-3
[5]	J. F. Weel, R. W. van der Hulst, et al., “Heterogeneity in Susceptibility to Metronidazole among Helicobacter pylori Isolates from Patients with Gastritis or Peptic ulcer Disease,” Journal of Clinical Microbiology, Vol. 34, No. 9, 1996, pp. 2158-2162.
[6]	T. Alarcón, D. Domingo and M. López-Brea, “Antibiotic Resistance Problems with Helicobacter pylori,” International Journal of Antimicrobial Agents, Vol. 12 No. 1, 1999, pp. 19-26. doi:10.1016/S0924-8579(99)00051-5
[7]	R. G. Lahaie and C. Gaudreau, “Helicobacter pylori Antibiotic Resistance: Trends over Time,” Canadian Journal of Gastroenterology, Vol. 14, No. 10, 2000, pp. 895-899.
[8]	L. C. Mollison, N. Stingemore, et al., “Antibiotic resistance in Helicobacter pylori,” Medical Journal of Australia, Vol. 173, No. 10, 2000, pp. 521-523.
[9]	S. Mendon?a, C. Ecclissato, et al., “Prevalence of Helicobacter pylori Resistance to Metronidazole, Clarithromycin, Amoxicillin, Tetracycline, and Furazolidone in Brazil,” Helicobacter, Vol. 5 No. 2, 2000, pp. 79-83. doi:10.1046/j.1523-5378.2000.00011.x
[10]	H. Miyaji, T. Azuma, et al., “Susceptibility of Helicobacter pylori Isolates to Metronidazole, Clarithromycin and Amoxycillin in Vitro and in Clinical Treatment in Japan,” Alimentary Pharmacology and Therapeutics, Vol. 11, No. 6, 1997, pp. 1131-1136. doi:10.1046/j.1365-2036.1997.00258.x
[11]	D. K. Bhasin, B. C. Sharma and P. Ray, “Drug Resistance in Helicobacter pylori Infection,” Indian Journal of Gastroenterology, Vol. 19, Suppl. 1, 2000, pp. 29-32.
[12]	M. A. Daw, P. Deegan, E. Leen and C. O’Moráin, “Short Report: The Effect of Omeprazole on Helicobacter pylori and Associated Gastritis,” Alimentary Pharmacology and Therapeutics, Vol. 5, No. 4, 1991, pp. 435-439. doi:10.1111/j.1365-2036.1991.tb00047.x
[13]	A. G. Fraser, J. Bickley, R. J. Owen and R. E. Pounder, “DNA Fingerprints of Helicobacter pylori before and after Treatment with Omeprazole,” Journal of Clinical Pathology, Vol. 45, No. 12, 1992, pp. 1062-1065. doi:10.1136/jcp.45.12.1062
[14]	R. J. Adamek, S. Suerbaum, et al., “Primary and Acquired Helicobacter pylori Resistance to Clarithromycin, Metronidazole, and Amoxicillin-Influence on Treatment Outcome,” American Journal of Gastroenterology, Vol. 93, No. 3, 1998, pp. 386-389.
[15]	T. J. Borody, P. Andrews, G. Fracchia, et al., “Omeprazole Enhances Efficacy of Triple Therapy in Eradicating Helicobacter pylori,” Gut, Vol. 37, No. 4, 1995, pp. 477-481. doi:10.1136/gut.37.4.477
[16]	G. Cederbrant, G. Kahlmeter and A. Ljungh, “The E Test for Antimicrobial Susceptibility Testing of Helicobacter pylori,” Journal of Antimicrobial Chemotherapy, Vol. 31, No. 1, 1993, pp. 65-71. doi:10.1093/jac/31.1.65
[17]	M. López-Brea, D. Domingo, I. Sánchez, et al., “Study of the Combination of Ranitidine Bismuth Citrate and Metronidazole against Metronidazole-Resistant Helicobacter pylori Clinical Isolates,” Journal of Antimicrobial Chemotherapy, Vol. 42, No. 3, 1998, pp. 309-314. doi:10.1093/jac/42.3.309
[18]	A. O. Aboderin, et al., “Antibiotic Resistance of Helicobacter pylori from Patients in Ile-Ife, South-West, Nigeria,” Africa Health Sciences, Vol. 7, No. 3, 2007, pp. 143-147.
[19]	W. D. Chey, et al., “American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection,” American Journal of Gastroenterology, Vol. 102, 2007, pp. 1808-1825. doi:10.1111/j.1572-0241.2007.01393.x
[20]	G. Dai, N. Cheng, L. Dong, et al., “Bactericidal and Morphological Effects of NE-2001, a Novel Synthetic Agent Directed against Helicobacter pylori,” Antimicrobial Agents and Chemotherapy, Vol. 49, 2005, pp. 3468-3473. doi:10.1128/AAC.49.8.3468-3473.2005
[21]	E. M. Quintana-Guzman, M. L. Arias-Echandi, et al., “Helicobacter pylori: Susceptibility to Amoxycillin, Erythromycin, Tetracycline, Ciprofloxacin, Nitrofurantoin and Metronidazole in Costa Rica,” Revista Biomédica, Vol. 9, 1998, pp. 92-96.