Arch Iran Med. 2018;21(7):283-288.
PMID: 30041525
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Original Article

Helicobacter pylori Multidrug Resistance Due to Misuse of Antibiotics in Iran

Parastoo Saniee 1, Farideh HosseinI 2, Sara Kadkhodaei 2, Farideh Siavoshi 2 * , Saman Khalili-Saman 2

1 Department of Microbiology, Faculty of Life Sciences and Biotechnology , Shahid Beheshti University G.C, Tehran, Iran
2 Department of Microbiology, School of Biology, University College of Sciences, University of Tehran, Tehran, Iran
*Corresponding Author: Farideh Siavoshi, PhD; Department of Microbiology, School of Biology, University College of Sciences, University of Tehran, P.O. Box: 14176-14411, Tehran, Iran. Tel: + 98 21 61112460, Fax: + 98 21 66492992, Email: Siavoshi@khayam.ut.ac.ir

Abstract

Background: Helicobacter pylori might become highly resistant to antibiotics taken through the life time of patients. This study examined the change in antibiotic resistance of H. pylori by time.

Methods: Out of 985 dyspeptic patients who were referred to the endoscopy unit of Shariati hospital during 2010-2017, 218 patients with gastric biopsies positive for rapid urease test (RUT) and H. pylori culture were recruited in the study. H. pylori isolates were examined for resistance to 8 currently used antibiotics by the disc diffusion method. Results were compared with those from our three previous studies. The frequency of multidrug resistance (MDR) was also assessed.

Results: The highest resistance rate was to metronidazole (MTZ) (79.4%) followed by ofloxacin (OFX) (58.7%), ciprofloxacin (CIP) (46.8%), levofloxacin (LVX) (45%), tetracycline (TET) (38.5%), clarithromycin (CLR) (34.4%), amoxicillin (AMX) (27.1%) and furazolidone (FRZ) (23.9%). No significant difference was found between resistance of H. pylori isolates from male and female <40 and >40 years old and patients with gastritis and peptic ulcer. The highest rates of MDR were to MTZ+OFX (4.6%), MTZ+OFX+TET (2.8%), MTZ+OFX+CIP+LVX (6.4%) and MTZ+OFX+TET+ CIP+LVX (5%).

Conclusion: Resistance to MTZ increased from 33%–55.6% in previous studies to 79.4% by time, to CLR increased from 1.4–7.3% to 34.4%, to TET increased from 0–38.1% to 38.5%, to AMX increased from 1.4%–7.3% to 27.1% and to FRZ increased from 0%–4.5% to 23.9%. Resistance to FQs was 45%–58.7%. Increase in H. pylori antibiotic resistance indicates antibiotic misuse. In Iran, with a considerable number of H. pylori- infected patients, antibiotic therapy should be saved for high risk patients and according to local antibiotic resistance patterns.

Cite this article as: Saniee P, Hosseini F, Kadkhodaei S, Siavoshi F, Khalili-Samani S. Helicobacter pylori Multidrug Resistance due to Misuse of Antibiotics in Iran. Arch Iran Med. 2018;21(7):283–288.
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Submitted: 28 Jul 2018
Accepted: 25 Apr 2018
First published online: 01 Jul 2018
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