title: Geographical difference in antimicrobial resistance pattern of Helicobacter pylori clinical isolates from Indian patients: Multicentric study.
abstract: OBJECTIVE
  To assess the pattern of antimicrobial resistance of Helicobacter pylori isolates from peptic ulcer disease patients of Chandigarh, Delhi, Lucknow, Hyderabad and Chennai in India, and to recommend an updated anti-H. pylori treatment regimen to be used in these areas.
  
  
  METHODS
  Two hundred and fifty-nine H. pylori isolates from patients with peptic ulcer disease reporting for clinical management to the Post Graduate Institute of Medical Education and Research, Chandigarh; All India Institute of Medical Sciences, New Delhi; Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow; Deccan College of Medical Sciences and Allied Hospitals, Hyderabad; and hospitals in Chennai in collaboration with the Dr ALM Post Graduate Institute of Basic Medical Sciences were analyzed for their levels of antibiotic susceptibility to metronidazole, clarithromycin, amoxycillin, ciprofloxacin and tetracycline. The Epsilometer test (E-test), a quantitative disc diffusion antibiotic susceptibility testing method, was adopted in all the centers. The pattern of single and multiple resistance at the respective centers and at the national level were analyzed.
  
  
  RESULTS
  Overall H. pylori resistance rate was 77.9% to metronidazole, 44.7% to clarithromycin and 32.8% to amoxycillin. Multiple resistance was seen in 112/259 isolates (43.2%) and these were two/three and four drug resistance pattern to metronidazole, clarithromycin, amoxycillin observed (13.2, 32 and 2.56%, respectively). Metronidazole resistance was high in Lucknow, Chennai and Hyderabad (68, 88.2 and 100%, respectively) and moderate in Delhi (37.5%) and Chandigarh (38.2%). Ciprofloxacin and tetracycline resistance was the least, ranging from 1.0 to 4%.
  
  
  CONCLUSIONS
  In the Indian population, the prevalence of resistance of H. pylori is very high to metronidazole, moderate to clarithromycin and amoxycillin and low to ciprofloxacin and tetracycline. The rate of resistance was higher in southern India than in northern India. The E-test emerges as a reliable quantitative antibiotic susceptibility test. A change in antibiotic policy to provide scope for rotation of antibiotics in the treatment of H. pylori in India is a public health emergency.
authors.affiliation: Departments of Microbiology and Gastroenterology, Dr ALM Post Graduate Institute of Basic Medical Sciences and Government General Hospital, Chennai, India. sptrajan@md4.vsnl.net.in
authors.forename: S P
authors.initials: SP
authors.lastname: Thyagarajan
authors.forename: Pallab
authors.initials: P
authors.lastname: Ray
authors.forename: Bimal Kumar
authors.initials: BK
authors.lastname: Das
authors.forename: Archana
authors.initials: A
authors.lastname: Ayyagari
authors.forename: Aleem Ahmed
authors.initials: AA
authors.lastname: Khan
authors.forename: S
authors.initials: S
authors.lastname: Dharmalingam
authors.forename: Usha Anand
authors.initials: UA
authors.lastname: Rao
authors.forename: P
authors.initials: P
authors.lastname: Rajasambandam
authors.forename: B
authors.initials: B
authors.lastname: Ramathilagam
authors.forename: Deepak
authors.initials: D
authors.lastname: Bhasin
authors.forename: M P
authors.initials: MP
authors.lastname: Sharma
authors.forename: S R
authors.initials: SR
authors.lastname: Naik
authors.forename: C M
authors.initials: CM
authors.lastname: Habibullah
mesh_terms: D000658:Amoxicillin / Q000494:pharmacology; D000890:Anti-Infective Agents / Q000494:pharmacology* / Q000627:therapeutic use; D002939:Ciprofloxacin / Q000494:pharmacology; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology*; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D007194:India / Q000453:epidemiology; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D010437:Peptic Ulcer / Q000382:microbiology*; D013752:Tetracycline / Q000494:pharmacology
chemical_list: D000890:Anti-Infective Agents; D008795:Metronidazole; D002939:Ciprofloxacin; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin