Management of antibiotic-resistant Helicobacter pylori infection: current perspective in Iran

Abstract

Helicobacter pylori is a common gastric bacterial pathogen implicated in the pathogenesis of many digestive tract disorders. H. pylori infection prevalence has been reported alarmingly in Iran. A plethora of studies have been conducted to evaluate the efficiency of first-line and second-line eradication attempts in patients diagnosed with H. pylori infections in Iran. The present study, was evaluated the efficacy of first-line and second-line therapy in H. pylori infections in Iran. We aimed to consider the literature review of the various library and electronic databases (Science Direct, PubMed, and Google Scholar) until 2020. The frequency of bacterial resistance to tetracycline, ampicillin, trimethoprim, erythromycin, ofloxacin, and metronidazolewas found to be high in Iran, while the most effective antibiotics were clarithromycin, rifampin, rifampicin, tetracycline, amoxicillin, ciprofloxacin, levofloxacin, moxifloxacin, and azithromycin. The therapeutic choice for H. pylori eradication in Iran could be quadruple therapy using two antibiotics amoxicillin and metronidazole/clarithromycin for the first-line regimen, and a combination of furazolidone plus tetracycline/amoxicillin and bismuth plus proton pump inhibitor for the second-line regimen. Due to increased antibiotic resistance in our region, empirical therapy must be replaced by more targeted treatment based on antimicrobial drug resistance profiles obtained from patients. Although we limited our investigation on the H. pylori eradication regimens in Iran, the results can be generalized to any region as long as the patterns of resistance are the same.

Keywords:

• Helicobacter pylori
• antibiotic resistance
• eradication
• Iran

Compliance with ethical standards

No funding was received for development of this manuscript.

Disclosure statement

No potential conflict of interest was reported by the authors.

Authors’ contributions

SA designed the manuscript and wrote the article; RG reviewing documents and organizing materials; FSH contributed to the interpretation of the results, conceived the original idea; ZA analysed experimental results and prepared tables; HEL investigated and supervised the findings of this work.

Notes on contributors

Samin Alihosseini, M.D. Researcher, Immunology Research Center, Tabriz University of Medical Sciences, Tabriz, Iran. Research Interests: Infection, Infectious Disease, Epidemiology, Infectious Diseases, Antibiotics, Diagnosis, Infection Control.

Reza Ghotaslou, M.D, Ph.D. FCLS. Professor, Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Research Interests: Antimicrobials, Antibiotic Resistance, Antibiotics, Nosocomial Infection, Helicobacter pylori, Gut microbiota, Antimicrobial stewardship.

Fatemah Sadeghpour Heravi, PhD. Researcher, Department of Microbiology, Pasteur Institute of Iran, Tehran, Iran. Research Interests: Antimicrobials, Antibiotic Resistance, Antimicrobial stewardship, Microbiota.

Zainab Ahmadian, Pharmacist, PhD. Researcher, Department of Pharmaceutics, School of Pharmacy, Zanjan University of Medical Science, 45139-56184 Zanjan, Iran. Research Interests: Pharmacology, Drug delivery, Antimicrobials, Antibiotic Resistance.

Hamed Ebrahimzadeh Leylabadlo, PhD. Researcher, Department of Bacteriology and Virology, School of Medicine, Tabriz University of Medical Sciences, Tabriz, Iran. Research Interests: Antimicrobials, Antibiotic Resistance, Antibiotics, Nosocomial Infection, Bacterial genetics, Helicobacter pylori, Gut microbiota.