title: Clarithromycin-Based Triple Therapy is Still Useful as an Initial Treatment forHelicobacter pyloriInfection in the Dominican Republic.
abstract: AbstractHelicobacter pyloriantibiotic susceptibility in the Dominican Republic has not been monitored. We assessedH. pyloriantibiotic susceptibility in the Dominican Republic, and analyzedH. pylorimutations associated with antibiotic resistance. We recruited 158 dyspeptic patients in Santo Domingo and used agar dilution to test susceptibility to five antibiotics. Polymerase chain reaction-based sequencing was used to assessgyrA,gyrB,rdxA,frxA, and 23S rRNA mutations; next-generation sequencing was used to identify other metronidazole resistance-associated genes. Among 64H. pyloristrains isolated, we identified two (3.1%), one (1.6%), and no strains with clarithromycin, amoxicillin, and tetracycline resistance, respectively. Moreover, high frequency of metronidazole resistance (53/64, 82.8%) was observed, whereas levofloxacin resistance is emerging (23/64, 35.9%). We identified manyrdxAandfrxAmutations in metronidazole-resistant strains, but no synergistic effect was apparent. We revealed novel mutations indppA,dppB,fdxA, andfdxB, irrespective ofrdxAandfrxAmutations. Novel mutations at Ser-14 oftrx1and Arg-221 ofdapFwere associated with different levels of metronidazole resistance. Most levofloxacin-resistant strains had a substitution at Asn-87 ofgyrA, including the strain with the highest levofloxacin resistance, whereas only three substitutions were found at Ser-479 ofgyrBwith no synergistic effect. Besides the 23S rRNA A2142G mutation, we observed another mutation at T1958G in both clarithromycin-resistant strains. We confirmed high metronidazole and levofloxacin resistance associated with genetic mutations in the Dominican Republic. However, prevalence of clarithromycin resistance was low, suggesting that standard clarithromycin-based triple therapy remains useful as initial treatment ofH. pyloriinfection.
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.|Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.|Gastroentero-Hepatology Division, Department of Internal Medicine, Faculty of Medicine-Dr. Soetomo Teaching Hospital-Institute of Tropical Disease, Universitas Airlangga, Surabaya, Indonesia.
authors.forename: Muhammad
authors.initials: M
authors.lastname: Miftahussurur
authors.affiliation: Institute of Microbiology and Parasitology, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic.|Department of Biomedical Research, National Institute of Medicine and Diagnostic Imaging, Santo Domingo, Dominican Republic.
authors.forename: Modesto
authors.initials: M
authors.lastname: Cruz
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Phawinee
authors.initials: P
authors.lastname: Subsomwong
authors.affiliation: Dominican-Japanese Digestive Disease Center, Dr. Luis E. Aybar Health and Hygiene City, Santo Domingo, Dominican Republic.
authors.forename: José A
authors.initials: JA
authors.lastname: Jiménez Abreu
authors.affiliation: Institute of Microbiology and Parasitology, Faculty of Science, Autonomous University of Santo Domingo, Santo Domingo, Dominican Republic.
authors.forename: Celso
authors.initials: C
authors.lastname: Hosking
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Nagashima
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.
authors.forename: Junko
authors.initials: J
authors.lastname: Akada
authors.affiliation: Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu, Japan.|Department of Medicine, Gastroenterology and Hepatology Section, Baylor College of Medicine, Houston, Texas.
authors.forename: Yoshio
authors.initials: Y
authors.lastname: Yamaoka
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000658:Amoxicillin / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D017291:Clarithromycin / Q000627:therapeutic use*; D004293:Dominican Republic; D024881:Drug Resistance, Bacterial / Q000235:genetics; D004359:Drug Therapy, Combination / Q000379:methods; D005260:Female; D005798:Genes, Bacterial; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics / Q000254:growth & development / Q000302:isolation & purification; D059014:High-Throughput Nucleotide Sequencing; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008297:Male; D008795:Metronidazole / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D008875:Middle Aged; D009154:Mutation; D012338:RNA, Ribosomal, 23S / Q000235:genetics; D013752:Tetracycline / Q000627:therapeutic use*
chemical_list: D000900:Anti-Bacterial Agents; D012338:RNA, Ribosomal, 23S; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D013752:Tetracycline; D017291:Clarithromycin