Helicobacter pylori antimicrobial resistance and antibiotic consumption in the low‐resource Central America setting
Year: 2019
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Antimicrobial resistance is a global public health problem, particularly in low- and middle-income countries (LMICs), where antibiotics are often obtained without a prescription. H. pylori antimicrobial resistance patterns are informative for patient care and gastric cancer prevention programs, have been shown to correlate with general antimicrobial consumption, and may guide antimicrobial stewardship programs in LMICs. We report H. pylori resistance and antimicrobial utilization patterns for western Honduras, representative of rural Central America. METHODS: In the context of the western Honduras gastric cancer epidemiology initiative, gastric biopsies from 189 patients were studied for culture and resistance patterns. Antimicrobial utilization was investigated for common H. pylori treatment regimens from regional public (7 antimicrobials) and national private (4 antimicrobials) data, analyzed in accordance with WHO anatomical therapeutic chemical defined daily doses (DDD) method and expressed as DDD/1000 inhabitants per day (DID) and per year (DIY). RESULTS: H. pylori was successfully cultured from 116 patients (56% males, mean age: 54), and nearly all strains were cagA+ and vacAs1m1+ positive (99% and 90.4%, respectively). Unexpectedly, high resistance was noted for levofloxacin (20.9%) and amoxicillin (10.7%), while metronidazole (67.9%) and clarithromycin (11.2%) were similar to data from Latin America. Significant associations with age, gender, or histology were not noted, with the exception of levofloxacin (28%, P = 0.01) in those with histology limited to non-atrophic gastritis. Total antimicrobial usage in western Honduras of amoxicillin (17.3 DID) and the quinolones had the highest relative utilizations compared with other representative nations. CONCLUSIONS: We observed significant H. pylori resistance to amoxicillin and levofloxacin in the context of high community antimicrobial utilization. This has implications in Central America for H. pylori treatment guidelines as well as antimicrobial stewardship programs.
Source: Helicobacter
DOI: 10.1111/hel.12595
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: U.S. Department of Veterans Affairs, AGA Research Foundation, National Institutes of Health, National Institute of Mental Health, National Cancer Institute, Fogarty International Center, National Institute of Diabetes and Digestive and Kidney Diseases, National Center for Advancing Translational Sciences
Awards: G1046522931, G1788375732, Etiological Studies of Gastric Carcinoma, Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (VECDor), G3706700131, G400951311, Vanderbilt-Emory-Cornell-Duke Consortium for Global Health Fellows (VECDor), G48435065, G5510211638, G6678749481, G725763919, The Vanderbilt Institute for Clinical and Translational Research (VICTR), Gastric Cancer Epidemiology Initiative in Central America, Investing in the Future to Promote Diversity in GI Training, Molecular and Cellular Basis for Digestive Diseases, H. pylori-induced Inflammation and Gastric Cancer
OpenAlex ID: W2946496253