Emerging levofloxacin and multidrug resistance in clinical isolates of helicobacter pylori in Peshawar Pakistan
DOI:
https://doi.org/10.59736/IJP.23.04.1031Keywords:
Antibiotic stewardship, Drug Resistance, Helicobacter PyloriAbstract
Background: Helicobacter pylori infection persists as a significant public health concern in developing countries and is a principal cause of gastritis, peptic ulcer disease, and gastric carcinoma. Rising resistance to clarithromycin and metronidazole jeopardizes empirical triple therapy and necessitates local molecular surveillance.
The objective of the study is to do molecular characterization of H. pylori isolated from dyspeptic patients and to perform antimicrobial susceptibility testing to guide the physicians for treatment strategies with symptoms of dyspepsia.
Methods: Gastric biopsies from symptomatic patients were cultured for H. pylori. DNA was extracted from 27 confirmed isolates and quantified by NanoDrop. Sample size was calculated using a standard formula based on a 92% expected prevalence, 95% confidence interval, and 5% margin of error. Molecular confirmation targeted the 16S rRNA gene using established primers. Antibiotic susceptibility testing was carried out by Kirby-Bauer disk diffusion method. Data were analysed descriptively and associations between prior antibiotic exposure and resistance were assessed.
Results: Molecular confirmation succeeded for the majority of cultured isolates. Markedly high resistance levels were observed to metronidazole and clarithromycin while amoxicillin resistance remained uncommon. Prior macrolide exposure was associated with increased likelihood of clarithromycin resistance.
Conclusion: H. pylori isolate from this tertiary care setting demonstrate clinically significant resistance to commonly used antibiotics, undermining empirical triple therapy. Routine susceptibility testing, molecular-guided therapy and antimicrobial stewardship are recommended to improve eradication rates and limit spread of resistance. Larger, regional multicenter surveillance and incorporation of molecular resistance testing into diagnostic workflows are urgently warranted.
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