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World J Gastroenterol. Oct 7, 2017; 23(37): 6920-6922
Published online Oct 7, 2017. doi: 10.3748/wjg.v23.i37.6920
Resistance of Helicobacter pylori to furazolidone and levofloxacin: A viewpoint
Mohammad Zamani, Arash Rahbar, Javad Shokri-Shirvani
Mohammad Zamani, Arash Rahbar, Student Research Committee, Babol University of Medical Sciences, Babol 47176-47745, Iran
Mohammad Zamani, Cancer Research Center, Health Research Institute, Babol University of Medical Sciences, Babol 47176-47745, Iran
Javad Shokri-Shirvani, Department of Internal Medicine, Babol University of Medical Sciences, Babol 47176-47745, Iran
ORCID number: Mohammad Zamani (0000-0003-1916-3873); Arash Rahbar (0000-0002-1935-2247); Javad Shokri-Shirvani (0000-0002-2090-2234).
Author contributions: Zamani M and Shokri-Shirvani J contributed in study design; Zamani M and Rahbar A drafted the manuscript; Shokri-Shirvani J revised the manuscript for important intellectual content; All authors have read the manuscript and approved its final version.
Conflict-of-interest statement: The authors declared no conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Javad Shokri-Shirvani, MD, Department of Internal Medicine, Babol University of Medical Sciences, Ganjafrooz Street, Babol 47176-47745, Mazandaran, Iran. j.shokri@mubabol.ac.ir
Telephone: +98-11-32199592 Fax: +98-11-32190971
Received: June 29, 2017
Peer-review started: June 30, 2017
First decision: July 13, 2017
Revised: July 30, 2017
Accepted: August 15, 2017
Article in press: August 15, 2017
Published online: October 7, 2017

Abstract

In their review, Arslan et al[1] did not describe the status of Helicobacter pylori (H. pylori) treatment with furazolidone and the resistance to this antibiotic. We have presented different surveys showing the resistance of H. pylori to furazolidone from Asia and South America. The resistance rates varied but were mostly low (< 5%). There are not enough data on its efficacy and resistance in the United States and Europe. H. pylori mutations occurring in the oorD gene, including A041G, A122G, C349A(G), A78G, A112G, A335G, C156T and C165T, and in the porD gene, including G353A, A356G, C357T, C347T, C347G and C346A, have been indicated to be possibly related to the observed resistance. Additionally, to complete Arslan et al’s statement regarding levofloxacin resistance, it should be noted that compound mutations of N87A, A88N and V65I at codon Asn-87 were recently observed in the gyrA gene for the first time. However, the results on these topics are not sufficient, and more worldwide studies are suggested.

Key Words: Susceptibility, Furazolidone, Helicobacter pylori, Resistance, Levofloxacin, Treatment

Core tip: We have presented different surveys showing the resistance of Helicobacter pylori (H. pylori) to furazolidone from Asia and South America. The resistance rates varied but were mostly low (< 5%). H. pylori mutations occurring in the oorD gene, including A041G, A122G, C349A(G), A78G, A112G, A335G, C156T and C165T, and in the porD gene, including G353A, A356G, C357T, C347T, C347G and C346A, have been indicated to be possibly related to the observed resistance. Regarding levofloxacin resistance, compound mutations of N87A, A88N and V65I at codon Asn-87 were recently observed in the gyrA gene for the first time.



TO THE EDITOR

We have read with great interest the valuable article by Arslan et al[1], titled “Importance of antimicrobial susceptibility testing for the management of eradication in Helicobacter pylori infection”. One of the main subjects of the review was the description of the resistance rates of different antibiotics and the potential mechanisms leading to decreased in Helicobacter pylori (H. pylori) antimicrobial susceptibility. However, the authors should consider clarifying two important issues.

The authors did not allude to the status of H. pylori treatment with furazolidone and the resistance to this antibiotic. We have provided existing surveys reporting the resistance of H. pylori to furazolidone in Table 1. The resistance rates have been mostly reported to be lower than 5%; however, these rates can vary geographically. Furazolidone is not used widely in the United States and Europe; therefore, there are not enough data on its efficacy and resistance in these regions.

Table 1 Studies evaluating the Helicobacter pylori resistance to furazolidone.
ContinentCountryStudy yearStrains (n)MethodResistance (%)Author
AsiaChina (Shanghai)2000-2009293Agar dilution0Sun et al[6]
China (Zhejiang)2010-201221Agar dilution0.1Su et al[7]
China (Zhejiang)2009-20149687Agar dilution< 0.01Ji et al[8]
India (Ghaziabad and New Delhi)NA68Agar dilution22.1Gehlot et al[9]
India (Gujarat)2008-201180Disk diffusion13.8Pandya et al[10]
Iran (Rasht)2012-2014169Disk diffusion61.9Maleknejad et al[11]
Iran (Shiraz)2004-2005106Agar dilution9.4Kohanteb et al[12]
Iran (Sari)2009197Disk diffusion61.4Abadi et al[13]
Iran (Tehran)2001-2004135Disk diffusion0Siavoshi et al[14]
Iran (Tehran)2002-200324Disk diffusion0Fallahi et al[15]
Iran (Tehran)2005-2008110Disk diffusion4.5Siavoshi et al[16]
Iran (Tehran)2007-2008104Disk diffusion0Sirous et al[17]
Iran2003-2005100Disk diffusion9Rafeey et al[18]
South Korea1994-1999220Agar dilution1.4Kim et al[19]
Malaysia (Malacca)200990Epsilometer test0Goh et al[20]
Pakistan (Karachi)2008-201393disk diffusion4.3Siddiqui et al[21]
South AmericaBrazil (Bragança Paulista)NA90Agar dilution4Mendonça et al[22]
Brazil (Bragança Paulista)NA138Agar dilution13Godoy et al[23]
Brazil (Sao Paulo)NA39Agar dilution0Eisig et al[24]
Brazil (Sao Paulo)2008-200977Agar dilution and disk diffusion0Ogata et al[25]
Brazil (Sao Paulo)2008-200977Agar dilution0Ogata et al[26]

One of the main reasons for the emergence of resistance is related to the extensive use of furazolidone. In addition, regarding the molecular mechanisms, some genetic mutations have been identified. Mutations occurring in the 2-oxoglutarate:acceptor oxidoreductase (oorD) gene, including A041G, A122G, C349A(G), A78G, A112G, A335G, C156T and C165T, and in the pyruvate oxidoreductase (porD) gene, including G353A, A356G, C357T, C347T, C347G and C346A, are possibly related to the resistance[2,3]. The oor and por genes are involved in the generation of acetyl coenzyme A (acetyl-CoA) and succinyl-CoA[4]. Despite these findings, additional molecular methods are proposed to reach a better understanding of the mechanisms that were mentioned.

Arslan et al[1] accurately documented the mechanism of levofloxacin resistance; i.e., point mutations in the gyrA (DNA gyrase) gene were stated to be potentially linked to the resistance. However, to complete their statement, it should be noted that compound mutations of N87A, A88N and V65I at codon Asn-87 were recently observed in the gyrA gene for the first time. L45F, A55S, A97V, D91N, R130K and G60S are other possible mutations that need to be assessed in studies with broader sample bases[5].

Footnotes

Manuscript source: Unsolicited manuscript

Specialty type: Gastroenterology and hepatology

Country of origin: Iran

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P- Reviewer: Ananthakrishnan N, Bao ZJ, Jamali R S- Editor: Ma YJ L- Editor: A E- Editor: Huang Y

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