Helicobacter pylori resistance to antibiotics at the An-Najah National University Hospital: a cross-sectional study

Background: Bacterial resistance to antibiotics is considered the most important determinant of treatment failure. Monitoring the evolution of antimicrobial resistance to common antibiotics is therefore of special importance for clinicians. The frequency of resistance to antibiotics in Helicobacter pylori isolates is increasing. The aim of this study was to determine the pattern of H pylori antibiotic resistance at the An-Najah National University Hospital.

Methods: In this cross-sectional study, we recruited patients older than 18 year who were admitted to the An-Najah National University Hospital. Participants underwent oesophageal gastroduodenoscopy and gastric biopsy in the hospital's laparoscopic department. Biopsies were taken from the gastric antrum and body during endoscope. The analysis of the biopsies included rapid urease test, histological examination to detect H pylori, and bacterial culture using selective media. After culturing the bacteria for 7 days, we tested oxidase, urease, and catalase activity. Cultures that were positive for H pylori were tested for their susceptibility to various antimicrobial agents. Ethical approval was obtained from the An-Najah National University before starting the data collection. All participants gave informed consent before the procedure.

Findings: Between July 1, 2016, and Jan 1, 2017, we enrolled 91 patients with dyspepsia (49 women and 42 men). 38 (42%) patients had an H pylori infection. H pylori was found in three (100%) of three patients with a duodenal ulcer, three (46%) of ten patients with a gastric ulcer, 20 (54%) of 37 patient with gastritis, and 12 (41%) of 29 patient with a normal endoscopic appearance. When isolates of H pylori isolates were subjected to sensitivity tests against six antibiotics, ciprofloxacin was the most effective drug against H pylori (0% resistance), followed by levofloxacin (0%), moxifloxacin (3%), and amoxicillin (18%). Metronidazole and clarithromycin were the least effective drugs, with resistance rates of 100% and 47%, respectively.

Interpretation: H pylori isolates from the Palestinian patients included in this study were highly resistant to the traditional first-line antibiotics clarithromycin and metronidazole. However, fluoroquinolones and amoxicillin are still effective antimicrobial choices. This could be the result of the unjustified wide use of antibiotics in the Palestinian community and the use of clarithromycin-based therapy as first-line treatment for H pylori, which in turn has led to increased rates of H pylori eradication failure. We recommend using quinolone-based regimens for H pylori and rationing the use of antibiotics in Palestinian patients.

Funding: An-Najah National University.