1002 Susceptibility of H pylori to ‘usual’ antibiotics in South Africa

In South Africa the usual regimen for treatment of H pylori includes amoxicillin, metronidazole, clarithromycin and doxycycline, with an expected efficacy of 85-95% in eradicating the organism. Such eradication is considered important given that the organism is said to affect more than 50% of the world’s population, is one of the most genetically diverse bacteria, and is considered a major cause of ulcers (duodenal and gastric), dyspepsia, reflux disease, gastric adenocarcinoma and mucosa-associated lymphoid tissue lymphoma (MALT) in many populations. Epidemiology might be different in developing countries, both in terms of resistance to usually-recommended antibiotics and in symptomatology/pathology. Two studies appearing in a recent issue of the South African Medical Journal address the latter two areas, one focusing on patients in the Eastern Cape Province, the other on Kenyans. The South African study explored antibiotic sensitivity and found that resistance to metronidazole was high (95.5%), possibly linked to widespread use of derivatives of this drug group for treatment of protozoal and gynaecological infections. While amoxicillin appeared to be effective (with susceptibility at 97.5%) there could be a question about the accuracy of this result since a) resistance has been shown in other countries, and b) methods of storage of samples (specifically freezing) might eradicate resistant strains. Ciprofloxacin was highly effective (100%), with lesser responses to gentamicin, tetracycline and erythromycin. The bottom line of that study is that clinicians should establish local susceptibility profiles and recognize that drugs such as metronidazole (and perhaps amoxicillin) might be ineffective, while ciprofloxacin could be the drug of choice. In the other African study, not only did children represent fully one-third of dyspeptic patients qualifying for investigation, but (possibly related to the latter), gastritis was the dominant clinical problem, affecting almost two-thirds of the 696 subjects.

Read more:
S Afr Med J 2010; 100: 49-52 and pp 53-57
Ann Trop Med Parasitol 2009; 103: 189-204
J Clin Microbiol 2004; 42: 4856-58