Prevalence and Pattern of Antibiotic Resistant Strains of Helicobacter Pylori Infection in ASEAN

Objective: Antibiotic resistance has significantly impact on eradication rates for H. pylori infection and remains
important cause of treatment failure worldwide including ASEAN countries. The aim of this study was to survey
the prevalence and antibiotic resistant pattern of H. pylori infection in ASEAN. Methods: This study was a survey among
26 experts from 9 ASEAN countries including Thailand, Cambodia, Indonesia, Laos, Malaysia, Myanmar, Philippines,
Singapore and Vietnam whom attended a meeting to develop the ASEAN consensus on H. pylori management in Bangkok
in November 2015. A questionnaire was sent to each member of the consensus meeting. The detail of the questionnaire
included information about prevalence of H. pylori infection, facilities to perform H. pylori culture, molecular testing
for antibiotic resistance and antibiotic resistance rate in their countries. Results: H. pylori infection remain common
in ASEAN ranging from 20% in Malaysia, 21-54% in Thailand and 69% in Myanmar. Most of ASEAN countries
can perform H. pylori cultures and antibiotic susceptibility tests except Laos and Cambodia. In ASEAN countries,
metronidazole resistant H pylori is quite common whereas amoxicillin resistance remain rare. Clarithromycin resistance
results in a significant decrease in H. pylori eradication rate with clarithromycin-containing regimens. The prevalence of
clarithromycin resistance varies in ASEAN countries being high in Vietnam (30%) and Cambodia (43%), moderate to high
in Singapore (17%) and low in Malaysia (6.8%), Philippine (2%) and Myanmar (0%). In Thailand, clarithromycin
resistance tends to higher in large cities (14%) than in rural areas (~3.7%). Conclusion: ASEAN countries should
develop a standard protocol for regular susceptibility testing of H. pylori so that clinicians would be better able to
choose reliably effective empiric therapies. The wide range of antibiotic resistance in ASEAN countries suggests that
the preferred first line regimen should be depend on the local antibiotic resistance other than single recommendation.