engleski

SENSITIVITY OF HELICOBACTER PYLORI TO METRONIDAZOLE AND MACROLIDS IN GERD/NUD AND PEPTIC ULCER PATIENTS WITH HELICOBACTER PYLORI ERADICATION FAILURE

Aim: Antibiotic resistance is a major cause of eradication failure in anti-H.pylori treatment. In this study we aimed to assess the sensitivity to metronidazole and macrolids (azithromycin, clarithromycin) in patients with previous eradication failure. Patients: 104 patients (M/F 46/58, 23-77 years aged), with gastritis (A group: GERD/NUD - 42 patients) and peptic ulcers (B group - 62 patients) who had failed H. pylori eradication after two or more standard triple therapy regimens were analized in this study. Each patient underwent upper GI endoscopy before and after every treatment. Two biopsy specimens in gastric antrum and two in the corpus were taken for histological examination and culture. Metronidazole, clarithromycin/azithromycin and amoxicillin resistance were determined by agar dilution MIC measurements. Results: There was no difference in primary prevalence of CLA/AZI and MET resistance among groups (A - 9, 1% and 32, 6% ; B – 8, 6% and 34, 7%- Fig.2). After multiple treatments, using both macrolids and metronidazole, prevalence of resistance was significantly different: In A group 71% to macrolids, 86% to metronidazole and in B group 26% to macrolids and 79% to metronidazole. Conclusion: This results suggest different approach to Helicobacter pylori eradication failure: In GERD/NUD patient we suggest quadruple therapy and in peptic ulcer patients, after taking culture and sensitivity testing, another triple therapy of longer duration may be efficient.

Helicobacter pylori; Eradication failure; culture

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