K. S. AHMED ET AL.
266
[11]. This difference in the sensitivity pattern observed in
western as well as in Asian isolates could be due to the
frequent use of the antibiotics to treat other infections.
Moreover, ineffective drug control policy also has a con-
tribution. Another Possibility could be due to infection
with different strains of H. pylori.
Results of our study support that Tetracyclin and
Ciprofloxacin could be the antibiotics of choice in the
eradication of H. pylori. It would be necessary to inves-
tigate ciprofloxacin in any eradication treatment regime
in our setting, since it appears to be the most active anti-
biotic in eradicating H. pylori in this environment.
5. Conclusion
It is observed that 96% - 97% of the clinical isolates were
sensitive to Tetracycline and Ciprofloxacin, where all
isolates were found to be resistant to Metronidazole. The
same resistance to metronidazole has also been reported
from other geographic regions. Resistance to Amoxycil-
lin and Clarithromycin were 80% and 76% respectively.
Studies attribute the high level of resistance to the fre-
quent use of the drugs to treat various other infections,
ineffective drug control policy and infection with differ-
ent strains of H. pylori. The relationship between antim-
icrobial resistance and the successful treatment of H.
pylori infection has dictated that a study of the incidence
of acquired antimicrobial resistance among H. pylori
isolates obtained within our environment be determined
hence the importance of this study. The ministry of
health should have an effective drug control policy. Fur-
thermore, there is the need to continue the evaluation of
new treatment agents such as NE-2001 [20], older agents
such as nitrofurantoin [21] or introduction of herbal
management in order to eradicate Helicobacter pylori.
Future case-control studies employing larger sample size
are needed to demonstrate the effectiveness or otherwise
of therapy in the different patient groups. A long-term
follow-up of our patients will also contribute to the de-
velopment of guidelines on the issues of referral, diag-
nostic methods and treatment of H. pylori.
6. Acknowledgements
We would like to thank our colleagues at our department
for their fruitful discussion during the research and their
technical assistance during manuscript preparation.
REFERENCES
[1] J. D. Penston, “Review Article: Helicobacter pylori Era-
dication under Standable Caution but No Excuse for Iner-
tia,” Alimentary Pharmacology and Therapeutics, Vol. 8,
No. 4, 1994, pp. 369-389.
doi:10.1111/j.1365-2036.1994.tb00304.x
[2] R. J. Laheij, L. G. Rossum, J. B. Jansen, H. Straatman
and A. L. Verbeek, “Evaluation of Treatment Regimens
to Cure Helicobacter pylori Infection—A Meta-Analy-
sis,” Alimentary Pharmacology and Therapeutics, Vol. 13,
No. 7, 1999, pp. 857-864.
doi:10.1046/j.1365-2036.1999.00542.x
[3] F. Mégraud, “Problems Caused by Antibiotic Resistance
of Helicobacter pylori,” La Presse Médicale, Vol. 26, No.
37, 1997, pp. 1775-1780.
[4] D. Y. Graham, “Antibiotic Resistance in Helicobacter
pylori: Implications for Therapy,” Gastroenterology, Vol.
115, No. 5, 1998, pp. 1272-1277.
doi:10.1016/S0016-5085(98)70100-3
[5] J. F. Weel, R. W. van der Hulst, et al., “Heterogeneity in
Susceptibility to Metronidazole among Helicobacter py-
lori Isolates from Patients with Gastritis or Peptic ulcer
Disease,” Journal of Clinical Microbiology, Vol. 34, No.
9, 1996, pp. 2158-2162.
[6] T. Alarcón, D. Domingo and M. López-Brea, “Antibiotic
Resistance Problems with Helicobacter pylori,” Interna-
tional Journal of Antimicrobial Agents, Vol. 12 No. 1,
1999, pp. 19-26. doi:10.1016/S0924-8579(99)00051-5
[7] R. G. Lahaie and C. Gaudreau, “Helicobacter pylori An-
tibiotic Resistance: Trends over Time,” Canadian Journal
of Gastroenterology, Vol. 14, No. 10, 2000, pp. 895-899.
[8] L. C. Mollison, N. Stingemore, et al., “Antibiotic resis-
tance in Helicobacter pylori,” Medical Journal of Austra-
lia, Vol. 173, No. 10, 2000, pp. 521-523.
[9] S. Mendonça, C. Ecclissato, et al., “Prevalence of
Helicobacter pylori Resistance to Metronidazole, Clarith-
romycin, Amoxicillin, Tetracycline, and Furazolidone in
Brazil,” Helicobacter, Vol. 5 No. 2, 2000, pp. 79-83.
doi:10.1046/j.1523-5378.2000.00011.x
[10] H. Miyaji, T. Azuma, et al., “Susceptibility of Helico-
bacter pylori Isolates to Metronidazole, Clarithromycin
and Amoxycillin in Vitro and in Clinical Treatment in
Japan,” Alimentary Pharmacology and Therapeutics, Vol.
11, No. 6, 1997, pp. 1131-1136.
doi:10.1046/j.1365-2036.1997.00258.x
[11] D. K. Bhasin, B. C. Sharma and P. Ray, “Drug Resistance
in Helicobacter pylori Infection,” Indian Journal of Gas-
troenterology, Vol. 19, Suppl. 1, 2000, pp. 29-32.
[12] M. A. Daw, P. Deegan, E. Leen and C. O’Moráin, “Short
Report: The Effect of Omeprazole on Helicobacter pylori
and Associated Gastritis,” Alimentary Pharmacology and
Therapeutics, Vol. 5, No. 4, 1991, pp. 435-439.
doi:10.1111/j.1365-2036.1991.tb00047.x
[13] A. G. Fraser, J. Bickley, R. J. Owen and R. E. Pounder,
“DNA Fingerprints of Helicobacter pylori before and af-
ter Treatment with Omeprazole,” Journal of Clinical Pa-
thology, Vol. 45, No. 12, 1992, pp. 1062-1065.
doi:10.1136/jcp.45.12.1062
[14] R. J. Adamek, S. Suerbaum, et al., “Primary and Ac-
quired Helicobacter pylori Resistance to Clarithromycin,
Metronidazole, and Amoxicillin-Influence on Treatment
Outcome,” American Journal of Gastroenterology, Vol.
93, No. 3, 1998, pp. 386-389.
[15] T. J. Borody, P. Andrews, G. Fracchia, et al., “Omepra-
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