Resistance to antibiotics used in the first-line treatment for H. pylori eradication

INTRODUCTION AND OBJECTIVE: It is well known that the clarithromycin resistance has been increasing in Turkey, consequently the effect of the classical treatment protocol (triple therapy) has decreased and the success of H.Pylori eradication with this treatment has dropped down under 60 %. Therefore, we have planned a research study aiming to investigate the resistance to levofloxacin, which has been suggested as an alternative to the classical treatment protocol, and its effectiveness in treatment.PATIENTS AND METHODS: In Dokuz Eylul University Faculty of Medicine, Department of Gastroenterology, biopsy samples (for culture studies) were taken from 116 patients during endoscopy between June 2010 and February 2011. Rapid Urease Tests were performed on the biopsy samples obtained from 52 patients. Sensitivity tests for amoxicillin, clarithromycin and levofloxacin were conducted with the E-test method. In our studies, the MIC values used for amoxicilin, clarithromycin, and levofloxacin were >0.5 µg/ml, ?1 µg/ml, and >1 µg/ml, respectively.RESULTS: Cultures were grown from biopsy samples taken from 52 (out of 116) patients. Amoxicillin, levofloxacin and clarithromycin resistances, determined with the E-test method, were found to be 15.4 %, 26.9 % and 25.5 % respectively.CONCLUSION: In this study, amoxicillin resistance was found to be 15.4 %. (If the two samples with intermediate sensitivity are not considered to be ?resistant?, amoxicillin resistance would be 11.5 %.) This resistance prevalence rate is much higher than the worldwide resistance prevalence of 0-3 %. Clarithromycin resistance was found to be 26.9 %, which is higher than the resistance upper limit of 20 %, determined by EHPSG for clarithromycin treatment. Significantly high amoxicillin and clarithromycin resistance prevalence rates determined in our studies can explain why the success rate of treatment with the classical triple therapy is not satisfactory. In this study, levofloxacin resistance was found to be 25.5 %. Hence, high success rates may not be possible with H.Pylori eradication treatment regimens with levofloxacin, and other regimens for H. Pylori (first step) treatment should be investigated. Based on our results, we can conclude that a regimen with levofloxacin is not an ideal treatment for patients with H.Pylori in Turkey.KEYWORDS: Turkey, H.pylori, levofloxacin, amoxicillin, clarithromycin resistance