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Paper Details

Resistance to Amoxicillin and Clarithromycin in Helicobacter pylori isolates in a tertiary care hospital  

Author Details : Lavanya Jeyamani*, Jayalakshmi Jayarajan, Ventatakrishnan Leelakrishnan, Mukundan Swaminathan

Journal Title:Indian Journal Of Microbiology Research

  Introduction: Amoxicillin and Clarithromycin are the two most often chosen first line drugs in eradication therapy for H. Pylori, owing to their better efficacy. Unlike other bacterial infections, therapy here is not based on individual susceptibility report for this bacterium. Rather an empirical regimen is chosen based on the prevalent resistance report in a given population. Current study is aimed at determining the resistance rate in our study population for amoxicillin (AMX) & Clarithromycin (CLA) and to determine if these two drugs can be continued as first line regimen. Materials and Methods: Gastric biopsy samples from 165 dyspeptic patients obtained through endoscopy was cultured in Brucella Chocolate agar (BCA). Among them 46 samples were showing sufficient growth of H. Pylori for antibiotic susceptibility testing. MIC for AMX and CLA was determined by E-strip method based on standard guidelines. Results: 91.3 percent of isolates were susceptible or moderately susceptible to CLA. Percentage of isolates within the proposed epidemiological cut off for AMX was 76. Conclusion: H.pylori isolates in our study population had resistance rate well below the cut off (20%) for CLA and it could be safely used as first line regimen in treating patients from this region of the country. On the contrary, more than 20% of the strains had MIC above the proposed Epidemiological cut off for AMX. Hence an increase in dosage and frequency of dosage, in combination with a potent anti-H.pylori drug could be used in treatment. Clinical trials are required to study efficacy of AMX based regimen in non susceptible patients. Serial monitoring of biological resistance is required for both these drugs, to determine the change in susceptibility pattern at the earliest. Keywords: Amoxicillin, Clarithromycin, Antibiotic susceptibility test, Minimum Inhibitory Concentration, Helicobacter pylori. Doi : 10.18231/j.ijmr.2019.063