title: Marked susceptibility of South African Helicobacter pylori strains to ciprofloxacin and amoxicillin: clinical implications.
abstract: OBJECTIVE
  Helicobacter pylori-associated infection is common in South Africa, as in other developing countries. Antibiotic resistance is recognised as a major cause of treatment failure. We studied the susceptibility and resistance patterns of H. pylori to guide empiric treatment and prevent the emergence of resistance.
  
  
  METHODS
  Two hundred H. pylori strains obtained from gastric biopsies of patients presenting with gastric-related morbidities attending Livingstone Hospital, Port Elizabeth, were evaluated for their susceptibility to seven antibiotics - metronidazole, clarithromycin, tetracycline, amoxicillin, gentamicin, ciprofloxacin and erythromycin. H. pylori was isolated following standard microbiology procedures, and susceptibility determined using the Kirby-Bauer disc diffusion and agar dilution methods. Comparisons of antimicrobial resistance rates with sex of the patients were determined using the chi-square test; a p-value of <0.05 was considered significant.
  
  
  RESULTS
  Marked susceptibility was observed for ciprofloxacin (100%) and amoxicillin (97.5%), and good activity for clarithromycin (80%) and gentamicin (72.5%). However, marked resistance (95.5%) was observed for metronidazole. The minimal inhibitory concentration (MIC) ranged from 0.0625 microg/ml to 8 microg/ml. The lowest MIC, with a range of 0.0625 - 1 microg/ml, was recorded for ciprofloxacin, while the highest (5 - 8 microg/ml) was noted for gentamicin.
  
  
  CONCLUSIONS
  Multidrug resistance was commonly encountered - a finding of clinical significance that calls for continuous surveillance of antibiograms to guide empiric treatment. We advocate the inclusion of ciprofloxacin in the treatment regimen of H. pylori infection in our study environment.
authors.affiliation: Department of Biochemistry and Microbiology, University of Fort Hare, Alice, E Cape.
authors.forename: Nicoline F
authors.initials: NF
authors.lastname: Tanih
authors.forename: Benjamin I
authors.initials: BI
authors.lastname: Okeleye
authors.forename: Nathan
authors.initials: N
authors.lastname: Naidoo
authors.forename: Anna M
authors.initials: AM
authors.lastname: Clarke
authors.forename: Noxolo
authors.initials: N
authors.lastname: Mkwetshana
authors.forename: Ezekiel
authors.initials: E
authors.lastname: Green
authors.forename: Lucy M
authors.initials: LM
authors.lastname: Ndip
authors.forename: Roland N
authors.initials: RN
authors.lastname: Ndip
mesh_terms: D000658:Amoxicillin / Q000494:pharmacology*; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D002939:Ciprofloxacin / Q000494:pharmacology*; D024901:Drug Resistance, Multiple, Bacterial; D004917:Erythromycin / Q000494:pharmacology; D005260:Female; D005839:Gentamicins / Q000494:pharmacology; D016481:Helicobacter Infections / Q000188:drug therapy / Q000382:microbiology*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D008297:Male; D008795:Metronidazole / Q000494:pharmacology; D008826:Microbial Sensitivity Tests; D013019:South Africa; D013752:Tetracycline / Q000494:pharmacology
chemical_list: D000900:Anti-Bacterial Agents; D005839:Gentamicins; D008795:Metronidazole; D002939:Ciprofloxacin; D004917:Erythromycin; D000658:Amoxicillin; D013752:Tetracycline