1. Academic Validation
  2. Effective therapeutic regimens in two South Asian countries with high resistance to major Helicobacter pylori antibiotics

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

  • Antimicrob Resist Infect Control. 2019 Feb 15;8:40. doi: 10.1186/s13756-019-0482-x.
Muhammad Miftahussurur  # 1 2 Hafeza Aftab  # 3 Pradeep Krishna Shrestha 4 Rabi Prakash Sharma 4 Phawinee Subsomwong 5 Langgeng Agung Waskito 2 5 Dalla Doohan 2 5 Kartika Afrida Fauzia 2 5 Yoshio Yamaoka 1 5 6 7
Affiliations

Affiliations

  • 1 1Division of Gastroentero-Hepatology, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital, Universitas Airlangga, Surabaya, 60131 Indonesia.
  • 2 2Institute of Tropical Disease, Universitas Airlangga, Surabaya, 60115 Indonesia.
  • 3 3Department of Gastroenterology, Dhaka Medical College and Hospital, Dhaka, Bangladesh.
  • 4 4Department of Gastroenterology, Maharajgunj Medical Campus, Tribhuvan University Teaching Hospital, Kathmandu, 44600 Nepal.
  • 5 5Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593 Japan.
  • 6 6Global Oita Medical Advanced Research Center for Health, Oita University, Oita, 870-1192 Japan.
  • 7 7Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX 77030 USA.
  • # Contributed equally.
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.

Keywords

Antibiotics; Bangladesh; Drug resistance; Helicobacter pylori; Nepal.

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