Helicobacter Pylori Infection and Frequency of Clarithromycin Resistance by qPCR

Authors

  • Samia Perwaiz Khan
  • Rubina Ghani
  • Safia Izhar
  • Ajeet Kumar
  • Ambreen Irshad
  • Shaista Emad
  • Aemen Moeen
  • Ayesha Abbasi
  • Maham Sattar
  • Syed Sohaib Hasan

DOI:

https://doi.org/10.51985/JBUMDC202244

Keywords:

Helicobacter pylori, triple therapy, quadruple therapy, qPCR–qualitative polymerase chain reaction, sequential therapy, ELISA (Enzyme-Linked Immunosorbent Assays)

Abstract

Objective: Determine the frequency of Helicobacter pylori (H. pylori) infection in our population, the response to triplequadruple regimen and resistance to clarithromycin.
Study Design and Setting: Study design is case-series, Medicare Cardiac & General Hospital, Karachi- 2020-2021. All
patients (N=110) were selected from outpatient department (OPD) of the Jinnah Medical College Hospital (JMCH) and
Medicare Cardiac and General Hospital.
Methodology: Patients with nausea, abdominal pain, diarrhea and IgG positive were included, and ELISA was done for
detection of H. pylori infection.. IgG negative for H. pylori and having other gastrointestinal infections were excluded from
this study. Patients positive with infection were prescribed the initial triple /quadruple regimen (triple regimen therapy
including Proton pump inhibitor (PPI) 20 mg, Metronidazole 400mg, Amoxicillin 250 mg or Quadruple therapy by adding
Bismuth subsalicylate). In ten cases of relapse Sequential / Rescue therapy were continued after a gap of 6 weeks included
PPI 20 mg, metronidazole 400mg ciprofloxacin 200mg BD or Levofloxacin 400 mg OD. The qPCR was performed for
the detecting resistant to clarithromycin in patients with H. pylori IgG positive after therapy.
Result: During the follow-up, 60 (54%) cases were recovered from initial triple regimen, whereas 40(36%) cases recovered
quadruple therapy and remaining 10 (7%) had clarithromycin resistance and were prescribed sequential therapy replacing
clarithromycin by fluoroquinolones.
Conclusion: The study showed that majority of H. pylori infected patient in our population recovered from initial
triple/quadruple regimen. The alternate option with clarithromycin resistant was sequential and rescue therapy with high
eradication rate.

References

Fallone CA, Moss SF, Malfertheiner P. “Reconciliation of

recent Helicobacter pylori treatment guidelines in a time of

increasing resistance to antibiotics.” Gastroenterology. 2019

;157(1):44–53. DOI: 10.1053/j.gastro.2019.04.011

Thung I, Aramin H, Vavinskaya V, Gupta S, Park JY, Crowe

SE, Valasek MA. Review article: the global emergence of

Helicobacter pylori antibiotic resistance. Alimentary

Pharmacology and Therapeutics, 2016: 43(4):514–33. doi:

1111/apt.13497

Godersk, K., Agudo Pena, S., and Alarcon, T.;“Helicobacter

pylori treatment: antibiotics or probiotics”. Appl Microbiol

Biotechnol. 2018:102:1–7 DOI: 10.1007/s00253-017-8535-

Latif S, Akhter N, Amjed S, Jafar J, Saleem B, et.al. Efficacy

of standard triple therapy versus Levofloxacin based alternate

therapy against Helicobacter pylori infection. Journal Pakistan

Medical Association (JPMA); 2018: 68: 1295-1299.

Mehmood K, Awan AA, Muhammad N, Hasan F, Nadir A.

Helicobacter pylori prevalence and histopathological findings

in dyspeptic patients. Journal of Ayub Medical College

Abbottabad.; 2014: 26(2):182-5.

Hooi, JKY, Lai WY, Ng WK, Suen, MMY, Underwood FE,

Tanyingoh, D et al. Global Prevalence of Helicobacter pylori

Infection: Systematic Review and Meta-Analysis.

Gastroenterology .2017; 153: 420–429.

Plummer , M. , Franceschi, S , Vignat, J, Forman, D., Martel,

C, Global burden of gastric Cancer attributable to Helicobacter

pylori Int J Cancer. 2015; 136(2):487-90. DOI: 10.1002/

ijc.28999

Samy W., Elnemr GM, Issa LF and Sedik W. “Prevalence of

Helicobacter Pylori Infection and its Correlation with Complete

Blood Count Parameters in Adult Males at Taif City, Saudi

Arabia”. SAS J. Med. 2016: Volume-2; Issue-3, p-49-54.

Zamani M, Ebrahimtabar F, Zamani V, Miller WH, AlizadehNavaei R, et.al; Systematic review with metanalysis: worldwide

prevalence of Helicobacter pylori infection. Alimentary

Pharmacology & Therapeutics. 2018: 47(7): 868–76, DOI:

1111/apt.14561

Nakamura S, and Matsumoto T. “Helicobacter pylori and

gastric mucosa-associated lymphoid tissue lymphoma: recent

progress in pathogenesis and management.” World Journal

of Gastroenterology (WJG). 2013:7;19(45):8181-7, doi:

3748/wjg. v19.i45.8181.

Bang CS, Lim H, Jeong HM, Shin WG, Choi JH, Soh JS.

Amoxicillin or tetracycline in bismuth-containing quadruple

therapy as first-line treatment for Helicobacter pylori infection.

; Gut Microbes, 11 ; 5:1314-1323, DOI: 10.1080/ 1949

2020.1754118

Ierardi E, Giorgio F, Iannone A, Losurdo G, Principi M, et.al.;

Noninvasive molecular analysis of Helicobacter pylori: is it

time for tailored first-line therapy? World Journal of

Gastroenterology. 2017: 23:2453–2458, doi: 10.3748/wjg.

v23.i14.2453

Rasheed F, Ahmad T, Bilal R.” Prevalence and risk factors

of Helicobacter pylori infection among Pakistani population.

Pakistan Journal of Medical Sciences.:2012: 28(4):661-665.

Kim SY, and Chung JW. “Best Helicobacter pylori Eradication

Strategy in the Era of Antibiotic Resistance. Antibiotics

(Basel).”; 2020: 23;9(8):436. doi: 10.3390/antibiotics9080436

Gasparetto M, Pescarin M, Guariso G. “Helicobacter pylori

eradication therapy: current availabilities.” ISRN

gastroenterology. 2012: Volume 2012, 8 doi:10.5402/ 2012/

Kageyama C, Sato M, Sakae H, Obayashi Y, Kawahara Y ,

et.al.; “Increase in antibiotic resistant Helicobacter pylori in

a University Hospital in Japan.” J of infection and drug

resistance. ; 2019: 12; 597-602. doi: 10.2147/IDR.S196452

Fasciana T, Di Carlo P, Jouini A, Di Giulio M.. “Helicobacter

pylori: infection and new perspective for the treatment.”

Canadian Journal of infectious diseases and Medical

Microbiology; 2019: 2 pages , doi.org/10.1155/2019/9431369.

Park JY, Shin T-S, Kim J-H, Yoon HJ, Kim BJ.et.al. “The

Prevalence of Multidrug Resistance of Helicobacter pylori

and Its Impact on Eradication in Korea from 2017 to 2019:

A Single-Center Study.” Antibiotics; 2020: 9(10), 646;

doi:10.3390/antibiotics9100646.

Hwang TJ, Kim N, Kim HB, Lee BH, Nam RH, et.al. “Change

in antibiotic resistance of Helicobacter pylori strains and the

effect of A2143G point mutation of 23S rRNA on the

eradication of H. pylori in a single center of Korea.” J. Clin.

Gastroenterol.; 2010: 44, 536–543. DOI: 10.1097/ MCG.

b013e3181d04592

Qureshi NN, Gallaher B, Schiller N.L “Evolution of amoxicillin

resistance of Helicobacter pylori in vitro: characterization of

resistance mechanisms.” Microb. Drug Resistance.; 2014:

(6):509–16. doi:10.1089/mdr.2014.0019.

Cao Z, Chen Q, Zhang W, Liang X, Liao J, et.al. “Fourteenday optimized levofloxacin-based therapy versus classical

quadruple therapy for Helicobacter pylori treatment failures:

a randomized clinical trial”. Scandinavian journal of

gastroenterology; 2015. 50(10):1185–90. doi:10.3109/ 0036-

.2015.1037345.

Gisbert JP, Romano M, Gravina AG, Solis-Munoz P, Bermejo

F, et al. “Helicobacter pylori second-line rescue therapy with

levofloxacin- and bismuth-containing quadruple therapy, after

failure of standard triple or non-bismuth quadruple

treatments.”Alimentary pharmacology & therapeutics.

:41(8):768–75, doi:10.1111/apt.13128.

Liou JM, Chen C-C, Lee Y-C, Chang C-Y, Wu J-Y, et.al.

“Systematic review with meta-analysis: 10- or 14-day

sequential therapy vs. 14-day triple therapy in the first line

treatment of Helicobacter pylori infection.” Alimentary

pharmacology & therapeutics.; 2016: 43(4):470–81.

doi:10.1111/apt.13495.

Wang B, Wang Y-H, Lv Z-F, Xiong H-F, Wang H, et.al.

“Review: efficacy and safety of hybrid therapy for Helicobacter

pylori infection: a systematic review and meta-analysis.

Helicobacter. 2015:20(2):79–88. doi:10.1111/hel.12180.

Zullo A, Fiorini G, Scaccianoce G, Portincasa P, De Francesco

V, et.al. “Sequential therapy for First-Line Helicobacter pylori

eradication: 10- or 14-Day Regimen?” Journal of

Gastrointestinal and Liver Diseases; 2019: Vol. 28 No 1: 11-

doi.org/10.15403/jgld.2014.1121.281.hpy

Downloads

Published

2022-10-06

How to Cite

Khan, S. P. ., Ghani, R. ., Izhar, S. ., Kumar, A. ., Irshad, A. ., Emad, S. ., Moeen, A. ., Abbasi, A. ., Sattar, M. ., & Hasan, S. S. . (2022). Helicobacter Pylori Infection and Frequency of Clarithromycin Resistance by qPCR. Journal of Bahria University Medical and Dental College, 12(04), 234–239. https://doi.org/10.51985/JBUMDC202244

Issue

Section

Original Articles