MOST OF THE HELICOBACTER PYLORI ISOLATES ARE RESISTANT TO LEVOFLOXACIN IN NORTH INDIA
Objective: Helicobacter pylori related gastro-duodenal diseases can be cured by proper treatment therapy. In India, the commercially available classic treatment therapy (proton pump inhibitor, amoxicillin, and clarithromycin) for bacterial eradication is available. However, antibiotic resistance to the commonly used triple regimen is increasing very rapidly. Considering that treatment including levofloxacin may be an alternative to the classic regimen. Therefore, we aimed to verify H. pylori isolates susceptibility to levofloxacin in India.
Methods: H. pylori were cultured from 56 patients suffering from different gastro-duodenal diseases. Minimum Inhibitory concentration to levofloxacin was determined by agar dilution method.
Results: The clinical diagnosis of 56 patients who were H. pylori culture positive were Gastro Esophageal Reflux Disease (GERD) (n=23), Non-erosive reflux Disease (NERD) (n=22), Non Ulcer Dyspepsia (NUD) (n=3), Antral Gastritis (n=2), Duodenal ulcer (n=1) and others (n=5). Of the 56 H. pylori isolates, the prevalence of levofloxacin resistance was found in 41 H. pylori isolates (73.2%).
Conclusion: We found that three-fourth of the isolated H. pylori strains of North India showed resistance to levofloxacin which is used for H. pylori treatment in other countries. Therefore, the conventional triple therapy comprising amoxicillin and clarithromycin is more appropriate for anti H. pylori management in India.
2. Megraud F. Helicobacter pylori and antibiotic resistance. Gut 2007;56:1502.
3. Thirumurthi S, Graham DY. Helicobacter pylori infection in India from a western perspective. Indian J Med Res 2012;136:549-62.
4. Bhatia V, Ahuja V, Das B, Bal C, Sharma MP. Use of imidazole-based eradication regimens for Helicobacter pylori should be abandoned in North India regardless of in vitro antibiotic sensitivity. J Gastroenterol Hepatol 2004;19:619â€“25.
5. Thyagarajan SP, Ray P, Das BK, Ayyagari A, Khan AA, Dharmalingam S, et al. Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: multicentric study. J Gastroenterol Hepatol 2003;18:1373-8.
6. Singh V, Mishra S, Maurya P, Rao G, Jain AK, Dixit VK, et al. Drug resistance pattern and clonality in H. pylori strains. J Infect Dev Countries 2009;3:130-6.
7. Pandya HB, Agravat HH, Patel JS, Sodagar NR. Emerging antimicrobial resistance pattern of Helicobacter pylori in central Gujarat. Indian J Med Microbiol 2014;32:408-13.
8. Seck A, Burucoa C, Dia D, Mbengue M, Onambele M, Raymond J, et al. Primary antibiotic resistance and associated mechanisms in Helicobacter pylori isolate from Senegalese patients. Ann Clin Microbiol Antimicrob 2013;12:3.
9. Megraud F. Current recommendations for Helicobacter pylori therapies in the world of evolving resistance. Gut Microbes 2013;4:1â€“8.
10. Georgopoulos SD, Papastergiou V, Karatapanis S. Current options for the treatment of Helicobacter pylori. Expert Opin Pharmacother 2013;14:211â€“23.
11. Datta S, Chattopadhyay S, Patra R, De R, Ramamurthy T, Hembram J, et al. Most Helicobacter pylori strains of Kolkata in India are resistant to metronidazole but susceptible to other drugs commonly used for eradication and ulcer therapy. Aliment Pharmacol Ther 2005;22:51â€“7.
12. Danjo A, Yamaguchi K, Fujimoto K, Saitoh T, Inamori M, Ando T, et al. Comparison of endoscopic findings with symptom assessment systems (FSSG and QUEST) for gastroesophageal reflux disease in Japanese centers. J Gastroenterol Hepatol 2009;24:633-8.
13. EUCAST. Breakpoint Tables for Interpretation of MICs and Zone Diameters. Version3.1; 2013.
14. Clinical Laboratory Standards Institute-Methods for Antimicrobial Dilution and Disk Susceptibility Testing of Infrequently Isolated or Fastidious Bacteria; Approved guideline. 2nd edition. CLSI document M45-A2. Vol. 30 Wayne, PA, USA: CLSI; 2010.
15. Zheng Q, Dai J, Li XB, Lu H, Xiao SD. Comparison of the efficacy of Pantoprazole based triple therapy versus quadruple therapy in the treatment of Helicobacter pylori infection: a single-center, randomized, open and parallel-controlled study. Weichangbingxui 2009;14:8-11.
16. Wolle K, Malfertheiner P. Treatment of Helicobacter pylori. Best Pract Res clin Gastroenterol 2007;21:315-24.
17. Xuan SH, Zhou YG, Wang HM. Advance in Helicobacter pylori resistance to clarithromycin. Shijie Huaren Xiaohua Zazhi 2008;16:3060-4.
18. Sun QJ, Liang X, Zheng Q, Gu WQ, Liu WZ, Xiao SD, et al. Resistance of Helicobacter pylori to antibiotics from 2000 to 2009 in shanghai. World J Gastroenterol 2010;16:5118-21.
19. Bilardi C, Dulbecco P, Zentilin P, Reglioni S, Irritano E, Parodi A, et al. A 10 d levofloxacin based therapy in patients with resistant Helicobacter pylori infection: a controlled trial. Clin Gastroenterol Hepatol 2004;2:997-1002.
20. Branca G, Spanu T, Cammarota G, Schito AM, Gasbarrini A, Gasbarrini GB, et al. High level of dual resistance to clarithromycin and metronidazole and in vitro activity of levofloxacin against Helicobacter pylori isolates from patients after the failure of therapy. Int J Antimicrob Agents 2004;24:433-8.