Effective therapeutic regimens in two South Asian countries with high resistance to major Helicobacter pylori antibiotics

Muhammad Miftahussurur†,
Hafeza Aftab†,
Pradeep Krishna Shrestha,
Rabi Prakash Sharma,
Phawinee Subsomwong,
Langgeng Agung Waskito,
Dalla Doohan,
Kartika Afrida Fauzia and
Yoshio YamaokaEmail author View ORCID ID profile

†Contributed equally

Antimicrobial Resistance & Infection Control20198:40

https://doi.org/10.1186/s13756-019-0482-x

Received: 27 November 2018
Accepted: 30 January 2019
Published: 15 February 2019

Abstract

Background

Nepal and Bangladesh have a high prevalence of Helicobacter pylori with high resistance rates to clarithromycin, metronidazole, and levofloxacin. Here, we evaluated the susceptibility and genetic mutations of 5 alternative antibiotics against isolates from both countries to obtain an effective treatment regimen for H. pylori eradication.

Methods

We used the agar dilution method to determine the minimal inhibitory concentration of 5 alternative antibiotics against 42 strains from Nepal and 56 from Bangladesh and performed whole genome mutation analysis.

Results

No resistance to furazolidone or rifabutin and a high susceptibility of sitafloxacin (95.2% in Nepal and 98.2% in Bangladesh) were observed. In contrast, resistance to rifaximin (52.4% in Nepal and 64.3% in Bangladesh) was high. Moreover, resistance to garenoxacin was higher in Bangladesh (51.6%) than in Nepal (28.6%, P = 0.041), most likely due to its correlation with levofloxacin resistance (P = 0.03). Garenoxacin and rifaximin were significantly correlated in Bangladesh (P = 0.014) and occurred together with all sitafloxacin-resistant strains. Mutations of gyrAcould play a significant role in garenoxacin resistance, and double mutations of A87 and D91 were associated with sitafloxacin resistance. Analysis of the rpoBgene demonstrated well-known mutations, such as V657I, and several novel mutations, including I2619V, V2592 L, T2537A, and F2538 L.

Conclusions

Rifabutin can be cautiously implemented as therapy for H. pylori infection due to its interaction with the tuberculosis endemic in Bangladesh. The high susceptibility of furazolidone and sitafloxacin suggests their possible future application in Nepal and Bangladesh.