Helicobacter pylori Antibiotic Resistance in Egypt: A Single-Center Study

Abstract

Helicobacter pylori (H. pylori) is the most common human bacterial infection worldwide, infecting approximately half of the world's population. Although antibiotic use is indicated for H. pylori eradication, the recommended type of antibiotic varies from country to country according to the H. pylori resistance pattern; developing countries, such as Egypt, may have different patterns than developed countries. We evaluated the antibiotic resistance of H. pylori in Egypt. Methods: This cross-sectional study included 134 adult patients with upper gastrointestinal (GI) complaints. Patients with a history of PPI during the last 2 weeks or antibiotics during the last 4 weeks before endoscopy were excluded. Upper GI endoscopies were performed and biopsies were collected for histopathology and H. pylori culture. Demographic, clinical, and endoscopic data were also collected. Antimicrobial susceptibility testing for H. pylori was performed for nine therapeutically relevant antibiotics using the Kirby-Bauer disc diffusion method. Results: The H. pylori antibiotic resistance rates were as follows: moxifloxacin, 10%; doxycycline, 15%; levofloxacin, 20%; clarithromycin, 40%; azithromycin, 40%; erythromycin, 65%; rifampicin, 90%; amoxicillin, 95%; and metronidazole, 100%. Dual resistance rates were 40% for amoxicillin/clarithromycin, 40% for metronidazole/clarithromycin, and 95% for amoxicillin/metronidazole. Conclusion:In Egyptian patients, H. pylori had >90% resistance to metronidazole and amoxicillin; modest resistance to erythromycin, azithromycin, and clarithromycin; and low resistance to moxifloxacin, and levofloxacin (≤20%). Dual resistance was high for amoxicillin/clarithromycin and amoxicillin/metronidazole, which prefers using quinolones rather than clarithromycin or metronidazole for first-line treatment of H. pylori in Egypt.

Helicobacter pylori Culture and Anti-biogram: Low Yield and Beneficial Results

“…In the current study, susceptibility testing showed that clarithromycin resistance was 54.5%, this agreed with Metwally et al (20) who found clarithromycin resistance (40%),…”

“…Regarding amoxicillin resistance in our study, it was universal as all (100%) patients showed resistance. This was similar to Metwally et al (20) and Mabeku et al (26) studies as they reported very high resistance rate (97.1% and 97% respectively). On the opposite side, lower rates of resistance were detected in other studies by Shao et al (29) and Tang et al (21) who reported a rate of 1.6% and 7.7% respectively.…”

“…In the current study 11% of patients' gastric biopsies showed positive culture growth for H. pylori. Other studies, found different rates of H. pylori culture growth, where 14.9%, 29.3% and 26.9% were detected in an Egyptian (20) ,Chinese (21) and Philippian studies. This discrepancy in results of culture growth may be referred to the number and site for biopsy taking, inadequate tissue sampling or different laboratory techniques (transport, processing, culture media and incubation).…”

“…Also, moxifloxacin (the other studied quinolone) in our study showed zero percent resistance. In the study of Metwally et al (20) resistance to moxifloxacin was 10%, and in Abdoh et al (23) it was 3%. This may suggest using moxifloxacin as one of the best antibiotics to treat H. pylori, but in other studies higher rates of resistance were reported, it was (42.9%) in Park et al (28) and 38.5% in Shao et al (29) study.…”

“…Similar data was reported by Abdoh et al (23) and Mabeku et al (26) . However, in the study of Metwally et al (20) it was 20%, while Tang et al (21) reported 28.2% using disk diffusion method and in Hamidi et al reported 28% (27) .…”