# Antibiotic Resistance Identification Among the Patients with Helicobacter pylori Infection: A Cross-sectional Study from Iran

## TL;DR

This study from Iran reports high antibiotic resistance rates in Helicobacter pylori strains, emphasizing the need for local resistance profiling to guide effective treatment.

## Contribution

The study provides the first report on antibiotic resistance patterns of H. pylori in Iran, highlighting unexpectedly high resistance to amoxicillin and tetracycline.

## Key findings

- 87.7% of H. pylori isolates were resistant to metronidazole.
- 63.1% of isolates showed resistance to clarithromycin.
- 34.2% of isolates were resistant to tetracycline, with resistance rates higher than expected.

## Abstract

The successful treatment of Helicobacter pylori infection is warranted only by using appropriate antimicrobial agents determined after performing antibiotic susceptibility tests. Determining the susceptibility profile of antibiotics currently used against H. pylori in each geographical region can be very practically beneficial for all drug prescribers.

In this cross-sectional study, we aim to identify the frequency of four antibiotics mainly referred to in the battle against H. pylori strains isolated from gastric biopsy specimens of 260 patients with dyspepsia referred to the gastroenterology clinics in Lorestan between 2020 and 2022, marking the first report from Iran. After culturing 260 gastric biopsy samples, H. pylori strains were identified using standard diagnostic methods.

The prevalence of antibiotic resistance among H. pylori isolates was reported using the antibiotic disc diffusion method with metronidazole, clarithromycin, amoxicillin, and tetracycline discs. Moreover, the minimum inhibitory concentration (MIC) of tetracycline-resistant H. pylori strains, screened by the diffusion disc method, was determined using the E-test method. Out of 260 biopsy samples, 187 (72%) samples (male: 42%, female: 58%) were H. pylori positive. The prevalence of antibiotic resistance rates among 187 isolates of H. pylori was as follows: metronidazole (87.7%, n = 166), clarithromycin (63.1%, n = 118), amoxicillin (39%, n = 73), and tetracycline (34.2%, n = 64), accordingly. Antibiotic resistance among H. pylori isolates was higher than expected, especially for amoxicillin and tetracycline, which is a concerning issue.

Consequently, considering the central role of the antibiotic susceptibility profile in experimental therapy, it is recommended that determining the resistance pattern of the bacterium in all parts of Iran can lead to an effective treatment regimen.