PRIMARY ANTIBIOTIC RESISTANCE OF HELICOBACTER PYLORI IN PEPTIC ULCER DISEASE PATIENTS

Background: Antibiotic resistance is the main cause of failure in Helicobacter pylori (H. pylori) eradication. Updating the antibiotic resistance situation of H. pylori in each region is important for recommending appropriate treatment regimens for the population and optimizing the effectiveness of H. pylori eradication treatment for each region and country. Objective: To determine the rate of primary antibiotic resistance of H. pylori strains to Amoxicillin (AMX), Clarithromycin (CLA), Levofloxacin (LEV), Metronidazole (MET), and Tetracycline (TET). Method: A cross-sectional descriptive study was performed on 216 patients with peptic ulcer disease who underwent endoscopy and antibiotic culture by Epsilometer test (E-test) at the American International Hospital from October 2019 to September 2022. Results: The rate of primary resistance to Clarithromycin was the highest at 96.30%, while the rates of resistance to Levofloxacin, Metronidazole, and Amoxicillin were 58.8%, 8.80%, and 2.78%, respectively. In the study, there were no cases of primary antibiotic resistance to Tetracycline, with a resistance rate of 0%. There was no statistically significant difference in the rate of resistance to each antibiotic between the male and female groups (p > 0.05). The rate of dual resistance to two antibiotics was very high, with 161/216 cases (74.54%), and the highest rate of resistance was to CLA + LEV with 124 cases (57.41%). The rates of H. pylori strains resistant to CLA + MET, MET + LEV, CLA + AMX, AMX + LEV, and AMX + MET were 7.41%, 3.7%, 2.78%, 1.39%, and 0.46%, respectively. There were 11 cases of H. pylori strains resistant to three types of antibiotics, a rate of 5.09%, and there were no cases resistant to four or more antibiotics. Only 1.39% remained sensitive to all five antibiotics in eradication regimens. Conclusion: The very high rate of resistance to Clarithromycin indicates that the standard triple regimen is no longer effective and should not be used in clinical practice. The regimen with Levofloxacin should be combined with Bismuth to enhance treatment effectiveness. The rates of resistance to Amoxicillin, Tetracycline, and Metronidazole were low, so a Bismuth quadruple or a combination of these three drugs may be very effective in eradicating H. pylori.