title: Helicobacter pylori Primary Antibiotic Resistance in 2015 in Morocco: A Phenotypic and Genotypic Prospective and Multicenter Study.
abstract: Knowledge of local antibiotic resistance is crucial to adaption of the choice of effective empirical first-line treatment for Helicobacter pylori infection. The aim of this study was to evaluate, for the first time in Morocco, the prevalence of the primary resistance of H. pylori to clarithromycin, metronidazole, amoxicillin, levofloxacin, tetracycline, and rifamycin. We conducted a 1-year prospective study (2015), including 255 Moroccan patients referred for gastro-duodenal endoscopy to two hospitals of Rabat (Morocco) and never previously treated for H. pylori infection. Three gastric biopsies were collected: one for histology, one for culture, and one for molecular detection of H. pylori and the mutations in 23S rRNA genes that confer resistance to clarithromycin. Antimicrobial susceptibility testing was performed on isolated strains by Etest and disk diffusion methods. One hundred seventy-seven patients were infected (69.4%). The prevalence of primary resistances of H. pylori to clarithromycin was 29%, 40% to metronidazole, 0% to amoxicillin, tetracycline, and rifamycin, and 11% to levofloxacin. Only four isolates (2%) were resistant to both clarithromycin and metronidazole. The high level of primary clarithromycin resistance in the H. pylori strains infecting the Moroccan population leads us to recommend the abandonment of the standard clarithromycin-based triple therapy as a first-line treatment in Morocco and to prefer a concomitant quadruple therapy.
authors.affiliation: 1 Laboratoire de Microbiologie, Université Mohammed V, Hôpital Universitaire Cheick-Zaid , Faculté de Médecine de Rabat, Rabat, Morocco .
authors.forename: Najat
authors.initials: N
authors.lastname: Bouihat
authors.affiliation: 2 EA 4331 LITEC, Université de Poitiers , CHU de Poitiers, Laboratoire de Bactériologie-Hygiène, Poitiers, France .
authors.forename: Christophe
authors.initials: C
authors.lastname: Burucoa
authors.affiliation: 3 Departement de Gastroentérologie II, Hôpital Militaire d'Instruction Mohammed V , Rabat, Morocco .
authors.forename: Ahmed
authors.initials: A
authors.lastname: Benkirane
authors.affiliation: 3 Departement de Gastroentérologie II, Hôpital Militaire d'Instruction Mohammed V , Rabat, Morocco .
authors.forename: Hassan
authors.initials: H
authors.lastname: Seddik
authors.affiliation: 3 Departement de Gastroentérologie II, Hôpital Militaire d'Instruction Mohammed V , Rabat, Morocco .
authors.forename: Sara
authors.initials: S
authors.lastname: Sentissi
authors.affiliation: 4 Pôle des laboratoires, Hôpital Militaire d'Instruction Mohamed V, équipe de recherche en pathologie tumorale, Faculté de Médecine de Rabat , Rabat, Morocco .
authors.forename: Abderrahmane
authors.initials: A
authors.lastname: Al Bouzidi
authors.affiliation: 5 Laboratoire de Microbiologie, Hôpital Militaire d'Instruction Mohammed V , Rabat, Morocco .
authors.forename: Mustapha
authors.initials: M
authors.lastname: Elouennas
authors.affiliation: 6 Laboratoire de Microbiologie, Hôpital Universitaire Cheick-Zaid, Université Abulcasis des Sciences de la Santé , Rabat, Morocco .
authors.forename: Amina
authors.initials: A
authors.lastname: Benouda
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D027081:DNA Gyrase / Q000235:genetics; D024901:Drug Resistance, Multiple, Bacterial / Q000187:drug effects / Q000235:genetics; D005260:Female; D005838:Genotype; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D008297:Male; D008826:Microbial Sensitivity Tests / Q000379:methods; D008875:Middle Aged; D009018:Morocco; D010641:Phenotype; D011446:Prospective Studies; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D012338:RNA, Ribosomal, 23S; D027081:DNA Gyrase
keywords: Helicobacter pylori; Morocco; antimicrobial susceptibility; eradication; resistance; therapeutic regimens