Antimicrobial resistance of Helicobacter pylori in Smolensk

Abstract

Objective. To study the antimicrobial resistance of H. pylori to clarithromycin, amoxicillin, metronidazole, levofloxacin, tetracycline in adult patients in the Smolensk region. Materials and Methods. Overall, 573 adult patients were included in 2015-2017 and 210 – in 20092010 with positive rapid urease test at the time of gastroscopy for dyspeptic complaints. Antimicrobial susceptibility testing of H. pylori isolates to clarithromycin, amoxicillin, metronidazole, levofloxacin and tetracycline was performed by the agar dilution method. Results. 143 and 133 strains of H. pylori isolated in 2015-2017 and in 2009-2010 were tested. The rates of resistance of H. pylori strains in 2015-2017 were 6.3% for clarithromycin, 1.4% – for amoxicillin, 23.8% – for metronidazole, 24.5% – for levofloxacin, 0.7% – for tetracycline. In 2009-2010 the corresponding numbers were: 5.3% – for clarithromycin, 4.5% – for amoxicillin, 3.8% – for metronidazole, 8.3% – for levofloxacin, 0% – for tetracycline. When assessing the dynamics of antimicrobial resistance of H. pylori in the Smolensk region over the past 9 years, there has been no noticeable increase in the resistance to clarithromycin, amoxicillin and tetracycline (p>0.05), with a significant increase in H. pylori resistance to metronidazole and levofloxacin (p<0,01). The resistance of H. pylori to metronidazole did not exceed the critical value of 40%. Conclusions. The prevalence of H. pylori resistance to clarithromycin and metronidazole in the Smolensk region was low throughout the study period, therefore standard triple therapy is recommended as a first line empirical therapy for H. pylori infection in adults. Preference in choosing a second-line empirical therapy between quadruple therapy with bismuth and triple therapy with levofloxacin should be stated in favor of quadruple therapy with bismuth because of the high rates of H. pylori resistance to levofloxacin.

Resistance of helicobacter pylori to antibacterial medications as a risk factor of infection development

“…It is especially important to examine H. pylori resistance to Clarithromycin and Metronidazole as these two medications are most frequently used to eliminate the microorganism. H. pylori resistance to other antibiotics that are also used quite often, namely Amoxicillin and Tetracycline, remains quite weak [8,9]. Clarithromycin produces direct anti-bacterial effects and is able to destroy matrices of biofilms that include the microorganism, promote its resistance to therapy with antibiotics, and protect the pathogen from a macro-organism's immune response.…”