Helicobacter Pylori Infection and Frequency of Clarithromycin Resistance by qPCR

Abstract

Objective: Determine the frequency of Helicobacter pylori (H. pylori) infection in our population, the response to triple quadruple regimen and resistance to clarithromycin. Study Design and Setting: Study design is case-series, Medicare Cardiac & General Hospital, Karachi- 2020-2021. All patients (N=110) were selected from outpatient department (OPD) of the Jinnah Medical College Hospital (JMCH) and Medicare Cardiac and General Hospital. Methodology: Patients with nausea, abdominal pain, diarrhea and IgG positive were included, and ELISA was done for detection of H. pylori infection.. IgG negative for H. pylori and having other gastrointestinal infections were excluded from this study. Patients positive with infection were prescribed the initial triple /quadruple regimen (triple regimen therapy including Proton pump inhibitor (PPI) 20 mg, Metronidazole 400mg, Amoxicillin 250 mg or Quadruple therapy by adding Bismuth subsalicylate). In ten cases of relapse Sequential / Rescue therapy were continued after a gap of 6 weeks included PPI 20 mg, metronidazole 400mg ciprofloxacin 200mg BD or Levofloxacin 400 mg OD. The qPCR was performed for the detecting resistant to clarithromycin in patients with H. pylori IgG positive after therapy. Result: During the follow-up, 60 (54%) cases were recovered from initial triple regimen, whereas 40(36%) cases recovered quadruple therapy and remaining 10 (7%) had clarithromycin resistance and were prescribed sequential therapy replacing clarithromycin by fluoroquinolones. Conclusion: The study showed that majority of H. pylori infected patient in our population recovered from initial triple/quadruple regimen. The alternate option with clarithromycin resistant was sequential and rescue therapy with high eradication rate.