High Clarithromycin Resistance and a Low Rate of Recurrence and Reinfection

Shahab Abid, Aga Khan University
javed Yakoob, Aga Khan University
Wasim Jafri, Aga Khan University
Z Abbas, Aga Khan University
k Mumtaz, Aga Khan University
Saeed Hamid, Aga Khan University
R Ahmad


BACKGROUND: In the current study the reinfection rate of H. pylori recurrence were investigated during a follow-up period of 12 months in adults who had undergone eradication therapy.

METHODS: One hundred-twenty patients, aged 18-77 years (117 with gastritis and 3 with duodenal ulcer), mean age 41± 13 years; male: female ratio was 80:40 were studied. H. pylori were cultured and antibiotic sensitivity was determined by Epsilometer test (E-test) for clarithromycin (CLR) and amoxicillin (AMX). Primers of urease gene C gene of H. pylori and Sau-3 and Hha I restriction enzymes were used for polymerase chain reaction-restriction fragment length polymorphism analysis (PCR-RFLP). C-14 urea breath test (14C-UBT) was performed 4 weeks after eradication therapy. Eradication was successful in 102(85%) patients and unsuccessful in 18 (15%). One hundred- two successfully treated patients were observed for 12 months with 14C-UBT to assess H. pylori status. If 14C-UBT was negative, it was repeated after every 12 weeks. If UBT was positive, EGD was repeated with biopsies. RESULT: The follow-up 14C-urea breath tests showed that all 102 patients remained free of infection at 9 months. Among 6 patients, the 14C-UBT confirmed recurrence at 12 months. The reinfection rate was 6%. The recurrence was associated with recrudescence in 2(2%) and reinfection in 4(4%). Forty-seven H. pylori isolates were cultured. Clarithromycin sensitivity was present in 30(64%) and amoxicillin in 45(98%), respectively.

CONCLUSION: H. pylori isolates demonstrated a high In Vitro clarithromycin resistance. It was associated with a low rate of recrudescence and reinfection in our patients with dyspepsia.