Korean J Gastroenterol.  2011 Apr;57(4):221-229. 10.4166/kjg.2011.57.4.221.

Regional Difference of Antibiotic Resistance of Helicobacter pylori Strains in Korea

• Kim JY
• Kim N
• Kim SJ
• Baik GH
• Kim GH
• Kim JM
• Nam RH
• Kim HB
• Lee DH
• Jung HC
• Song IS

• KMID: 1718402
• DOI: http://doi.org/10.4166/kjg.2011.57.4.221

Abstract

BACKGROUND/AIMS
This study was performed to compare the prevalence rates of primary antibiotic resistance in Helicobacter pylori (H. pylori) isolates among different regions of Korea.
METHODS
H. pylori were isolated from gastric mucosal biopsy specimens of 99 Koreans who lived in Gyeonggi (n=40), Kangwon province (n=40) and Busan (n=19) from April to August in 2008. All the patients had no history of H. pylori eradication therapy. The susceptibilities of the H. pylori isolates to amoxicillin, clarithromycin, metronidazole, tetracycline, azithromycin, ciprofloxacin, levofloxacin, and moxifloxacin were tested according to the agar dilution method.
RESULTS
There was a difference in resistance to clarithromycin in three institutes located among Gyeonggi (32.5%), Kangwon province (12.5%) and Busan (42.1%) by One way ANOVA test (p=0.027) and nonparametric Kruskal Wallis test (p=0.027). However, by post-hoc analysis, there was no statistically significant difference among three regions. Similarly, the other 7 antibiotics (amoxicillin, metronidazole, tetracycline, azithromycin, ciprofloxacin, levofloxacin and moxifloxacin) did not show any significant difference.
CONCLUSIONS
There was no significant regional difference of the primary antibiotic resistance of H. pylori. However, the included patient number might not be enough for this conclusion demanding further evaluations.

Keyword

Helicobacter pylori; Antibiotic resistance

MeSH Terms

Amoxicillin/pharmacology
Anti-Bacterial Agents/pharmacology/therapeutic use
Aza Compounds/pharmacology
Azithromycin/pharmacology
Ciprofloxacin/pharmacology
Clarithromycin/pharmacology
*Drug Resistance, Bacterial
Female
Helicobacter Infections/*epidemiology/microbiology
Helicobacter pylori/*drug effects/isolation & purification
Humans
Male
Metronidazole/pharmacology
Microbial Sensitivity Tests
Middle Aged
Ofloxacin/pharmacology
Quinolines/pharmacology
Republic of Korea/epidemiology
Tetracycline/pharmacology

Figure

• 

  Fig. 1. Minimal inhibitory concentration (MIC) distributions of antibiotics for H. pylori: MICs of amoxicillin (A), clarithromycin (B), metronidazole (C), tetracycline (D), azithromycin (E), ciprofloxacin (F), levofloxacin (G) and moxifloxacin (H). The dotted line indicates the break point of each antibiotic.

• 

  Fig. 2. Rate of antibiotics resistant H. pylori in three different regions. AMO, amoxicillin; CLA, clarithromycin; MTZ, metronidazole; TC, tetracycline; AZI, azithromycin; CPR, ciprofloxacin; LEVO, levofloxacin; MOXI, moxifloxacin. Resistant cut-off values were defined as >0.5μ g/ mL for amoxicillin (AMO), >1 μ g/mL for clarithromycin (CLA), >8 μ g/ mL for metronidazole (MTZ), >4 μ g/mL for tetracycline (TC), >1 μ g/ mL for azithromycin (AZI), ciprofloxacin (CPR), levofloxacin (LEVO) and moxifloxacin (MOXI).

• 

  Fig. 3. Frequency of multi-drug resistance in three different regions. Five antibiotics denote amoxicillin, clarithromycin, metronidazole, tetracycline and quinolone (ciprofloxacin, levofloxacin and moxifloxacin). There was no strain resistant to all antibiotics.

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