Internal Medicine

Biography

Biography: Muhammad Miftahussurur

Abstract

Information about antibiotic resistance for Helicobacter pylori infection in Indonesia was missing; we therefore aimed to determine the antibiotic susceptibility of H. pylori in Indonesia and determined the association of virulence genes with antibiotic resistance rate also the presence of genetic mutations associated with antibiotic resistance.  We recruited 849 patients with dyspeptic symptom who underwent endoscopy at 11 cities of Indonesia. E-test method was used to determine the minimum inhibitory concentration (MIC) of five antibiotics. Only 9.1% had clarithromycin resistance. The low prevalence was also found in amoxicillin and tetracycline resistance (5.2% and 2.6%, respectively). In contrast, metronidazole and levofloxacin demonstrated high resistance rate (46.7% and 31.2%, respectively). Strains taken in Sumatera island had significantly higher metronidazole resistance than other locations (P = 0.006). Ambonese had higher metronidazole and tetracycline resistance than other ethnics (both P = 0.01). There was significant association of tetracycline resistance with positivity of cagA (P = 0.004). We identified 95.5% of metronidazole resistant strains had highly distributed rdxA amino acid substitution. We also found the A2143G mutation of 23SrRNA in clarithromycin resistant strains (42.9%). However, one strain with the highest MIC value was related with novel mutated sequences of hp1314 (rpl22) without involvement of A2143G mutation. Additionally, 86.7% of levofloxacin-resistant strains had gyrB mutation at Asn-87 and/or Asp-91. The gyrB mutation had steady relationship with the gyrA 87-91 mutations. Clarithromycin- or metronidazole-based triple therapy should be taken with caution or culture-based therapy should be taken into account in some regions/ethnics of Indonesia.