Brief Article
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World J Gastroenterol. Sep 7, 2013; 19(33): 5508-5512
Published online Sep 7, 2013. doi: 10.3748/wjg.v19.i33.5508
Antibiotics resistance rate of Helicobacter pylori in Bhutan
Ratha-korn Vilaichone, Yoshio Yamaoka, Seiji Shiota, Thawee Ratanachu-ek, Lotay Tshering, Tomohisa Uchida, Toshio Fujioka, Varocha Mahachai
Ratha-korn Vilaichone, Gastroenterology Unit, Department of Medicine, Thammasat University Hospital, Pathumthani 12120, Thailand
Yoshio Yamaoka, Seiji Shiota, Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Yoshio Yamaoka, Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, TX 77030, United States
Thawee Ratanachu-ek, Department of Surgery, Rajavithi Hospital, Bangkok 10400, Thailand
Lotay Tshering, Department of Surgery, Jigme Dorji Wangchuck National Referral Hospital, Thimphu 1148, Bhutan
Tomohisa Uchida, Department of Molecular Pathology, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Toshio Fujioka, Department of Gastroenterology, Oita University Faculty of Medicine, Yufu 879-5593, Japan
Varocha Mahachai, GI and Liver Center, Bangkok Medical Center, Bangkok 10310, Thailand
Author contributions: Vilaichone R, Yamaoka Y and Mahachai V designed the study and carried out most of the study; Vilaichone R, Yamaoka Y, Ratanachu-ek T, Tshering L, and Uchida T provided the collection of data; Vilaichone R, Yamaoka Y and Shiota S wrote the manuscript, analyzed and interpreted data; Fujioka T provided valuable suggestions in the preparation of the manuscript; Yamaoka Y approved the version to be published.
Supported by Grants from the National Institutes of Health, DK62813 to Yamaoka Y; National Research University Project of Thailand Office of Higher Education Commission to Vilaichone R, Mahachai V; Grants-in-Aid for Scientific Research from the Ministry of Education, Culture, Sports, Science and Technology of Japan, No. 22390085, 22659087, 24406015 and 24659200 to Yamaoka Y; The Japan Society for the Promotion of Science Institutional Program for Young Researcher Overseas Visits to Fujioka T, Yamaoka Y; The Strategic Funds for the Promotion of Science and Technology from Japan Science and Technology Agency to Fujioka T, Yamaoka Y
Correspondence to: Yoshio Yamaoka, MD, PhD, Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, 1-1 Idaigaoka, Hasama-machi, Yufu-City, Oita 879-5593, Japan. yyamaoka@oita-u.ac.jp
Telephone: +81-97-5865740 Fax: +81-97-5865749
Received: February 2, 2013
Revised: April 13, 2013
Accepted: May 16, 2013
Published online: September 7, 2013
Processing time: 219 Days and 4.8 Hours
Abstract

AIM: To survey the antibiotic resistance pattern of Helicobacter pylori (H. pylori) strains isolated from Bhutanese population.

METHODS: We isolated 111 H. pylori strains from the gastric mucosa of H. pylori-infected patients in Bhutan in 2010. The Epsilometer test was used to determine the minimum inhibitory concentrations (MICs) of amoxicillin (AMX), clarithromycin (CLR), metronidazole (MNZ), levofloxacin (LVX), ciprofloxacin (CIP), and tetracycline (TET).

RESULTS: Nineteen of the isolated H. pylori strains were susceptible to all antibiotics tested. The isolated strains showed the highest rate of antibiotic resistance to MNZ (92/111, 82.9%). Among the 92 MNZ-resistant strains, 74 strains (80.4%) showed high-level resistance (MIC ≥ 256 μg/mL). Three strains were resistance to LVX (2.7%). These strains were also resistance to CIP. None of the strains showed resistance to CLR, AMX and TET.

CONCLUSION: CLR-based triple therapy is a more effective treatment approach over MNZ-based triple therapy for H. pylori infection in Bhutan.

Keywords: Helicobacter pylori; Drug resistance; Bhutan

Core tip: In Bhutan, 82.9% of Helicobacter pylori isolates showed metronidazole resistance. Of these, 80.4% showed high-level resistance (minimum inhibitory concentration ≥ 256 μg/mL). Only 2.7% strains showed levofloxacin, ciprofloxacin resistance. Intriguingly, none of them were resistance to clarithromycin, amoxicillin, and tetracycline.