Abstract
BackgroundAntibiotic combination therapy for Helicobacter pylori eradication must be adapted to local resistance patterns, but the epidemiology of H. pylori resistance to antibiotics is poorly documented in Africa. The aim was to determine the antibiotic resistance rates, as well as the associated molecular mechanisms, of strains isolated in Dakar, Senegal.MethodsOne hundred and eight H. pylori strains were isolated between 2007 and 2009 from 108 patients presenting with upper abdominal pain to the Gastroenterology Department of Le Dantec Hospital. Antimicrobial susceptibility testing was performed for amoxicillin, clarithromycin, metronidazole, levofloxacin and tetracyclin using the E-test method. Mutations in the 23S rRNA gene of clarithromycin-resistant strains and in gyrA and gyrB of levofloxacin-resistant strains were investigated.ResultsIsolates were characterized by no resistance to amoxicillin (0%), tetracycline (0%), and very low rate of resistance to clarithromycin (1%), but a high rate of resistance to metronidazole (85%). The clarithromycin-resistant strain displayed the A2143G mutation. A worrying rate of levofloxacin resistance was detected (15%). N87I and D91N were the most common mutations in the quinolone-resistance-determining region of gyrA.ConclusionsThe first-line empirical regimen for H. pylori eradication in Senegal should include clarithromycin. Increasing rates of fluoroquinolone resistance detected should discourage the use of levofloxacin-containing regimens without prior antimicrobial susceptibility testing.
Highlights
Antibiotic combination therapy for Helicobacter pylori eradication must be adapted to local resistance patterns, but the epidemiology of H. pylori resistance to antibiotics is poorly documented in Africa
Patients and antibiotic susceptibility testing One hundred eight H. pylori isolates were cultured from gastric biopsy samples obtained from volunteers during gastroduodenal endoscopy at Le Dantec Hospital (Dakar, Senegal) between 2007 and 2009
The lack of resistance to amoxicillin and tetracycline in this study indicates that H. pylori resistance to these agents is probably exceptional (0 to 1.3%) and low (0 to 4.4%), respectively, whatever the continent [21,23]
Summary
Antibiotic combination therapy for Helicobacter pylori eradication must be adapted to local resistance patterns, but the epidemiology of H. pylori resistance to antibiotics is poorly documented in Africa. The aim was to determine the antibiotic resistance rates, as well as the associated molecular mechanisms, of strains isolated in Dakar, Senegal. Helicobacter pylori is associated with severe gastroduodenal disorders, including peptic ulcer disease, gastric adenocarcinoma, and gastric mucosa-associated lymphoid tissue lymphoma [1]. All guidelines worldwide recommend the eradication of H. pylori in symptomatic patients [2]. This treatment commonly consists of tripleagent therapy with a double-dose proton pump inhibitor (PPI) and two antibiotics chosen from amoxicillin, of the gyrA gene, coding for the A subunit of the DNA gyrase, at codons 86, 87, 88 and 91 [3]. We examined the prevalence of H. pylori resistance to antibiotics, and the associated molecular mechanisms, in symptomatic African patients in Dakar (Senegal)
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