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Ibrahim ME. Epidemiology, pathogenicity, risk factors, and management of Helicobacter pylori infection in Saudi Arabia. BIOMOLECULES & BIOMEDICINE 2024; 24:440-453. [PMID: 37787623 PMCID: PMC11088898 DOI: 10.17305/bb.2023.9575] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Revised: 09/22/2023] [Accepted: 10/02/2023] [Indexed: 10/04/2023]
Abstract
Helicobacter pylori (H. pylori) is a gastric microbial pathogen that infects approximately half of the global population. This bacterium significantly contributes to various gastroduodenal diseases, including chronic active gastritis, peptic ulcerations, and malignant transformations. This review focuses on epidemiology, pathogenicity, virulence genes, risk factors, and management of H. pylori infection, specifically within the context of Saudi Arabia. The results presented here are grounded in studies conducted in Saudi Arabia, contrasting with mere bibliographic reviews of findings from other countries. H. pylori infection has been observed in Saudi Arabia, with substantial differences in the prevalence, ranging between 10-96% among various studied populations. Several risk factors for H. pylori infection have been identified, encompassing socioeconomic status, medical history, personal hygiene, and behavioral practices. Among the virulence genes harbored by H. pylori, cytotoxin-associated gene A (cagA) and vacuolating cytotoxin (vacA) are most common, with their presence correlating with the pathogenicity and clinical manifestations of the associated diseases. A range of invasive and non-invasive diagnostic assays have been utilized to identify H. pylori infection, with their employment being influenced by factors like availability, cost, patient age, gastric symptoms, and the specifics of clinical information sought. While detection methods like the H. pylori stool antigen test and the urea breath test offer more accuracy and speed, culturing remains indispensable for determining the antimicrobial susceptibility profile. The emergence of resistant strains across varying regional settings poses a significant challenge to treatment endeavors, necessitating an assessment of local antimicrobial resistance rates prior to formulating treatment strategies. The findings of this review highlight the importance of continuous implementation of screening, control, and prevention of H. pylori infection to combat the spreading infection and other related complications.
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Affiliation(s)
- Mutasim E Ibrahim
- Department of Basic Medical Sciences, College of Medicine, University of Bisha, Bisha, Saudi Arabia
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Saeedi FA, Hegazi MA, Alsaedi H, Alganmi AH, Mokhtar JA, Metwalli EM, Hamadallah H, Siam GS, Alaqla A, Alsharabi A, Alotaibi SA. Multidrug-Resistant Bacterial Infections in Pediatric Patients Hospitalized at King Abdulaziz University Hospital, Jeddah, Western Saudi Arabia. CHILDREN (BASEL, SWITZERLAND) 2024; 11:444. [PMID: 38671661 PMCID: PMC11049043 DOI: 10.3390/children11040444] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/28/2024]
Abstract
Multidrug-resistant bacterial infections (MDRIs) constitute a major global threat due to increased patient morbidity/mortality and hospital stay/healthcare costs. A few studies from KSA, including our locality, addressed antimicrobial resistance in pediatric patients. This study was performed to recognize the incidence and clinical/microbiologic features of MDRIs in hospitalized pediatric patients. A retrospective cross-sectional study included pediatric patients < 18 years, admitted to King Abdulaziz University Hospital, between October 2021 and November 2022, with confirmed positive cultures of bacteria isolated from blood/body fluids. Patients' medical files provided the required data. MDR organisms (MDROs) were identified in 12.8% of the total cultures. The incidence of MDRIs was relatively high, as it was detected in 42% of patients and in 54.3% of positive bacterial cultures especially among critically ill patients admitted to the NICU and PICU. Pneumonia/ventilator-associated pneumonia was the main type of infection in 37.8% of patients with MDROs. Klebsiella pneumoniae was the most common significantly isolated MDRO in 39.5% of MDR cultures. Interestingly, a low weight for (no need for their as terminology weight for age is standard and well-known) was the only significant risk factor associated with MDROs (p = 0.02). Mortality was significantly higher (p = 0.001) in patients with MDROs (32.4%) than in patients without MDROs (3.9%). Patients who died including 85.7% of patients with MDROs had significantly longer durations of admission, more cultures, and utilized a larger number of antibiotics than the surviving patients (p = 0.02, p = 0.01, p = 0.04, respectively). This study provided a comprehensive update on the seriously alarming problem of MDROs, and its impacts on pediatric patients. The detected findings are crucial and are a helpful guide to decid for implementing effective strategies to mitigate MDROs.
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Affiliation(s)
- Fajr A. Saeedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Moustafa A. Hegazi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
- Department of Pediatrics, Faculty of Medicine in Mansoura, Mansoura University Children’s Hospital, Mansoura 35516, Egypt
| | - Hani Alsaedi
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ahmed Hussain Alganmi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Jawahir A. Mokhtar
- Department of Clinical Microbiology and Immunology, Faculty of Medicine, King Abdulaziz University Hospital, Jeddah 80215, Saudi Arabia;
- Vaccines and Immunotherapy Unit, King Fahad Medical Research Center, King Abdulaziz University, Jeddah 80216, Saudi Arabia
| | | | - Hanaa Hamadallah
- Department of Pediatrics, Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (F.A.S.); (H.A.); (H.H.)
| | - Ghassan S. Siam
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alaqla
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Abdullah Alsharabi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
| | - Sultan Ahmed Alotaibi
- Faculty of Medicine in Rabigh, King Abdulaziz University, Jeddah 80205, Saudi Arabia; (A.H.A.); (A.A.); (A.A.); (S.A.A.)
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Almansour K, Malik JA, Rashid I, Ahmed S, Aroosa M, Alenezi JM, Almatrafi MA, Alshammari AA, Khan KU, Anwar S. Physician's Knowledge and Attitudes on Antibiotic Prescribing and Resistance: A Cross-Sectional Study from Hail Region of Saudi Arabia. Healthcare (Basel) 2023; 11:healthcare11111576. [PMID: 37297716 DOI: 10.3390/healthcare11111576] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Revised: 05/06/2023] [Accepted: 05/24/2023] [Indexed: 06/12/2023] Open
Abstract
BACKGROUND Antibiotic (AB) resistance is caused partly by overuse, varies by region, and is influenced by prescriber perspectives. This study sought to determine physicians' knowledge and attitudes toward AB prescribing, particularly in the Hail region of Saudi Arabia. METHODS An interdisciplinary team created and validated an electronic questionnaire via the test-retest method that measured reliability and consistency. The 19 questions covered the following subjects: demographic information (7), experience with AB resistance in daily work (3), AB prescribing behavior (2), communication with patients regarding AB resistance (3), and prescribing practices (4). The revised questionnaire was prepared and distributed to physicians in the Hail region via multiple electronic communication channels. Inferences were drawn based on descriptive statistics and multivariate regression analysis. RESULTS The questionnaire responses of 202 participants were eligible for analysis. A total of 70 (34.80%) participants were general practitioners, 78 (38.12%) were engaged in daily work that was only mildly related to AB resistance, and 25 (12.37%) performed work that was substantially related to AB resistance. A total of 88 (43.56%) physicians believed that prescribing behavior contributed to the emergence of AB resistance, whereas 68 (33.66%) did not. Regarding exposure, 51 (25.24%) physicians reported encountering instances of AB resistance monthly, whereas 104 (51.48%) reported seeing cases of AB resistance very rarely. In terms of prescribing practices, 99 (49.0%) physicians prescribed ABs to patients daily and 73 (36.13%) weekly. Regarding AB-resistance-related communication with patients, 73 (36.13%) physicians frequently discussed AB resistance with patients suffering from infections, whereas 13 (6.4%) never discussed it with patients. CONCLUSION General practitioners in the Hail region exhibited comprehensive awareness of the elements that contribute to AB resistance but only rarely communicated about the issue with their patients, presuming the latter to be oblivious to the science behind AB resistance. Our findings suggest that the features underlying practitioners' AB prescribing behavior could be a powerful strategy for lowering AB resistance.
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Affiliation(s)
- Khaled Almansour
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
| | - Jonaid Ahmad Malik
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Guwahati 781101, India
- Department of Biomedical Engineering, Indian Institute of Technology Ropar, Rupnagar 140001, India
| | - Ishfaq Rashid
- Department of Pharmacy Practice, M.M. College of Pharmacy, Maharishi Markandeshwar University, Mullana-Ambala 133207, India
| | - Sakeel Ahmed
- Department of Pharmacology and Toxicology, National Institute of Pharmaceutical Education and Research, Mohali 160062, India
| | - Mir Aroosa
- Department of Pharmacology, Jamia Hamdard University, New Delhi 110062, India
| | - Jehad M Alenezi
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
| | - Mohammed A Almatrafi
- Department of Pharmaceutics, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
| | | | - Kashif Ullah Khan
- Department of Clinical Pharmacy, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
| | - Sirajudheen Anwar
- Department of Pharmacology and Toxicology, College of Pharmacy, University of Hail, Hail 55476, Saudi Arabia
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Srisuphanunt M, Wilairatana P, Kooltheat N, Duangchan T, Katzenmeier G, Rose JB. Molecular Mechanisms of Antibiotic Resistance and Novel Treatment Strategies for Helicobacter pylori Infections. Trop Med Infect Dis 2023; 8:163. [PMID: 36977164 PMCID: PMC10057134 DOI: 10.3390/tropicalmed8030163] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2022] [Revised: 03/06/2023] [Accepted: 03/06/2023] [Indexed: 03/18/2023] Open
Abstract
Helicobacter pylori infects approximately 50% of the world's population and is considered the major etiological agent of severe gastric diseases, such as peptic ulcers and gastric carcinoma. Increasing resistance to standard antibiotics has now led to an ever-decreasing efficacy of eradication therapies and the development of novel and improved regimens for treatment is urgently required. Substantial progress has been made over the past few years in the identification of molecular mechanisms which are conducive to resistant phenotypes as well as for efficient strategies to counteract strain resistance and to avoid the use of ineffective antibiotics. These involve molecular testing methods, improved salvage therapies, and the discovery of novel and potent antimicrobial compounds. High rates of prevalence and gastric cancer are currently observed in Asian countries, including Japan, China, Korea, and Taiwan, where concomitantly intensive research efforts were initiated to explore advanced eradication regimens aimed at reducing the risk of gastric cancer. In this review, we present an overview of the known molecular mechanisms of antibiotic resistance and discuss recent intervention strategies for H. pylori diseases, with a view of the research progress in Asian countries.
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Affiliation(s)
- Mayuna Srisuphanunt
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Excellent Center for Dengue and Community Public Health, School of Public Health, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Polrat Wilairatana
- Department of Clinical Tropical Medicine, Faculty of Tropical Medicine, Mahidol University, Bangkok 10400, Thailand
| | - Nateelak Kooltheat
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Hematology and Transfusion Science Research Center, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Thitinat Duangchan
- Department of Medical Technology, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
- Hematology and Transfusion Science Research Center, School of Allied Health Sciences, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Gerd Katzenmeier
- Akkhraratchakumari Veterinary College, Walailak University, Nakhon Si Thammarat 80160, Thailand
| | - Joan B. Rose
- Department of Fisheries and Wildlife, Michigan State University, East Lansing, MI 48823, USA
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Muacevic A, Adler JR, Algamdi AG, Al-Dubai S. Perception of Antibiotic Prescribing and Resistance Among Hospital Physicians in Medina City, Saudi Arabia. Cureus 2023; 15:e33296. [PMID: 36741624 PMCID: PMC9894638 DOI: 10.7759/cureus.33296] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/02/2023] [Indexed: 01/04/2023] Open
Abstract
Background Overuse or misuse of broad-spectrum antibiotics appeared to be a major cause of increased antibiotic resistance. This study aimed to explore awareness and knowledge of antibiotic prescribing and resistance among hospital physicians in Medina, Saudi Arabia. Methodology A cross-sectional study was conducted among 223 physicians in seven public hospitals in Medina, Saudi Arabia. A validated self-administered questionnaire was used, including questions on sociodemographics, awareness about the current scope of antibiotic resistance, knowledge and frequency of antibiotic prescribing, confidence and input seeking, factors influencing antibiotic prescribing, and attitude toward antibiotic use. t-Test and analysis of variance (ANOVA) tests were used to compare total knowledge scores across the sociodemographic variables. The level of significance was set at 0.05. Results Most participants were aware that antibiotic resistance is a problem in Saudi Arabia (87.4%) and worldwide (93.3%). The majority of physicians (77.6%) were classified as having moderate knowledge, the mean knowledge score on antibiotics was 4.41, and 26.5% of the respondents prescribed antibiotics more than once daily. Most physicians (91.4%) were confident in antibiotic prescribing, and 94.1% of them consulted (at least sometimes) colleagues before prescribing. Factors associated with knowledge were age (P = 0.001), educational level (P = 0.002), working years (P = 0.004), current position (P = 0.003), specialty (P = 0.023), duration since graduation from medical school (P = 0.002), and duration since the last qualification (P = 0.022). Conclusions The majority of physicians had a moderate knowledge level of antibiotics, and most of them were prescribing antibiotics more than two times per week. Most respondents agreed that antimicrobial resistance is a worldwide concern and that it is a problem in Saudi Arabia. This study recommends training and courses on the fact that appropriate antibiotic prescribing should be ensured to have the best practice in antibiotic prescription among physicians.
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Kabrah A. Extended-Spectrum Beta-Lactamase and Carbapenem-Resistant Gram-Negative Pathogens in Makkah, Saudi Arabia. Ethiop J Health Sci 2022; 32:1221-1230. [PMID: 36475249 PMCID: PMC9692147 DOI: 10.4314/ejhs.v32i6.20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2022] [Accepted: 08/15/2022] [Indexed: 12/13/2022] Open
Abstract
Background This study aimed to determine the prevalence of extended-spectrum-beta-lactamase (ESBL) and carbapenem-resistant gram-negative bacteria (GNB) isolated from patients at the King Faisal Hospital in Makkah, Saudi Arabia. Methods In this cross-sectional study, a total of 298 patients admitted to the intensive care unit for 48 hours and who had a central venous catheter were selected using a census sampling method. Only patients with ESBL and carbapenem-resistant GNB-isolated organisms (175 patients) were included. The susceptibility test of GNB was carried out according to the standard recommendations. The identified strains were tested in-vitro against several antimicrobial drugs. Statistical analysis was performed using SPSS version 24. Results 36(20.6%) of samples were ESBL-producing GNB, whereas 139(79.4%) were carbapenem-resistant GNB. The pooled proportional estimates of ESBL-producing GNB Escherichia coli, Klebsiella pneumoniae, and other GNB were 44.4%, 41.6%, and 14.0%, respectively; the pooled proportional estimates of carbapenem resistance GNB Klebsiella pneumoniae, Acinetobacter baumannii complex/hemolyticus and other GNB were 82.8%, 10.8%, and 6.4%, respectively. All ESBL-producing GNB and carbapenem-resistance GNB were multidrug-resistant pathogens. The highest carbapenem resistance GNB 139(100%) was to ampicillin, and the lowest 122(87.7%) was to Amoxicillin/clavulanic acid (Amox/clav). All ESBL-producing GNB 36 (100%) were resistant to cefotaxime, and 35 (97.2%) were resistant to ampicillin, cefuroxime, cefepime, and ceftazidime. Additionally, the effective antibiotic against ESBL-producing GNB was imipenem. Conclusion Antibiotic utilization measures appear to contribute to the control of the emergence of multidrug-resistant pathogens such as ESBL and carbapenem-resistant GNB. Strict adherence to well-accepted infection control guidelines along with caution in using broad-spectrum antimicrobial agents represents the best strategy for preventing the emergence and spread of multidrug-resistant pathogens.
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Affiliation(s)
- Ahmed Kabrah
- Laboratory Medicine Department, Faculty of Applied Medical Sciences, Umm Al-Qura University, Makkah, Kingdom of Saudi Arabia
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Alomar HA, Fathallah N, Abdel-Aziz MM, Ibrahim TA, Elkady WM. GC-MS Profiling, Anti- Helicobacter pylori, and Anti-Inflammatory Activities of Three Apiaceous Fruits' Essential Oils. PLANTS (BASEL, SWITZERLAND) 2022; 11:2617. [PMID: 36235480 PMCID: PMC9570728 DOI: 10.3390/plants11192617] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Revised: 09/29/2022] [Accepted: 09/30/2022] [Indexed: 06/16/2023]
Abstract
Eradication of Helicobacter pylori is a challenge due to rising antibiotic resistance and GIT-related disorders. Cuminum cyminum, Pimpinella anisum, and Carum carvi are fruits belonging to the Apiaceae family. Their essential oils were extracted, analyzed using GC-MS, tested for anti-H. pylori activity by a micro-well dilution technique, identified for potential anti-H. pylori inhibitors by an in-silico study, and investigated for anti-inflammatory activity using a COX-2 inhibition assay. Results showed that the main components of C. cyminum, P. anisum, and C. carvi were cumaldehyde (41.26%), anethole (92.41%), and carvone (51.38%), respectively. Essential oil of C. cyminum exhibited the greatest anti-H. pylori activity (3.9 µg/mL) followed by P. anisum (15.63 µg/mL), while C. carvi showed the lowest activity (62.5 µg/mL). The in-silico study showed that cumaldehyde in C. cyminum has the best fitting energy to inhibit H. pylori.C. cyminum essential oil showed the maximum ability to reduce the production of Cox-2 expression approaching celecoxib with IC50 = 1.8 ± 0.41 µg/mL, followed by the C. carvi oil IC50 = 7.3 ± 0.35 µg/mL and then oil of P. anisum IC50 = 10.7±0.63 µg/mL. The investigated phytochemicals in this study can be used as potential adjunct therapies with conventional antibiotics against H. pylori.
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Affiliation(s)
- Hatun A. Alomar
- Pharmacology and Toxicology Department, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
| | - Noha Fathallah
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
| | - Marwa M. Abdel-Aziz
- Regional Center for Mycology and Biotechnology (RCMB), Al-Azhar University, Cairo 11651, Egypt
| | - Taghreed A. Ibrahim
- Department of Pharmacognosy, College of Pharmacy, King Saud University, Riyadh 11451, Saudi Arabia
- Department of Pharmacognosy, Faculty of Pharmacy, Cairo University, Cairo 11562, Egypt
| | - Wafaa M. Elkady
- Department of Pharmacognosy and Medicinal Plants, Faculty of Pharmacy, Future University in Egypt, Cairo 11835, Egypt
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Azab ET, Thabit AK, McKee S, Al-Qiraiqiri A. Levofloxacin versus clarithromycin for Helicobacter pylori eradication: are 14 day regimens better than 10 day regimens? Gut Pathog 2022; 14:24. [PMID: 35668511 PMCID: PMC9169378 DOI: 10.1186/s13099-022-00502-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2022] [Accepted: 05/23/2022] [Indexed: 11/16/2022] Open
Abstract
Background Helicobacter pylori eradication by the conventional clarithromycin therapy has largely dropped in the recent years possibly due to antimicrobial resistance. Hence, levofloxacin-based regimen has been used as salvage therapy. However, data regarding its effectiveness on eradication are controversial. This study aimed to compare the eradication rate of levofloxacin-based regiment to that of the conventional first-line clarithromycin regimen. Methods Patients diagnosed with H. pylori infection and treated with levofloxacin triple therapy or clarithromycin-based regimen for 10 or 14 days were included. Patients were excluded if they used antibiotics or proton pump inhibitors within 4 or 2 weeks, respectively, of the H. pylori eradication confirmation test. H. pylori eradication rate was assessed, as well as the impact of diabetes and esophagogastroduodenoscopy (EGD) findings. Results Of 245 patients, 145 were in the levofloxacin group and 100 in the clarithromycin group. Most patients in either group received therapy for 14 days vs. 10 days (P = 0.002). Levofloxacin-based treatment was associated with a higher eradication rate compared with clarithromycin-based treatment (74.5 vs. 62%, respectively; P = 0.04). The 14 day levofloxacin-based regimen resulted in the highest eradication rate, followed by the 14 day regimen of clarithromycin (80.9 vs. 66.3%; P = 0.03). The 10 day regimens exhibited 62.7 and 41.2% eradication rates, respectively (P = 0.12). H. pylori eradication was not affected by diabetes or EGD findings (P = 0.98 and 0.3, respectively). Conclusions Results from this study support the use of a levofloxacin-based regimen as a first-line therapy in the treatment of H. pylori infection for 14 days regardless of diabetes and EGD findings.
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Pellicano R, Ribaldone DG, Caviglia GP. Strategies for Helicobacter pylori eradication in the year 2020. Saudi J Gastroenterol 2020; 26:63-65. [PMID: 32295934 PMCID: PMC7279073 DOI: 10.4103/sjg.sjg_95_20] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Affiliation(s)
- Rinaldo Pellicano
- Unit of Gastroenterology Molinette Hospital, University of Turin, Turin, Italy,Address for correspondence: Dr. Rinaldo Pellicano, Outpatients Clinic of Gastroenterology, Molinette.S.G.A.S. Hospitals, Via Cavour 31, III piano, 10100 Torino, Italy. E-mail:
| | - Davide Giuseppe Ribaldone
- Unit of Gastroenterology Molinette Hospital, University of Turin, Turin, Italy,Department of Medical Sciences, University of Turin, Turin, Italy
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Alsohaibani F, Alquaiz M, Alkahtani K, Alashgar H, Peedikayil M, AlFadda A, Almadi M. Efficacy of a bismuth-based quadruple therapy regimen for Helicobacter pylori eradication in Saudi Arabia. Saudi J Gastroenterol 2020; 26:84-88. [PMID: 32295933 PMCID: PMC7279072 DOI: 10.4103/sjg.sjg_626_19] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND/AIM The treatment efficacy of Helicobacter pylori (H. pylori) has been decreasing over time due to resistance to multiple antimicrobial therapies. The most effective treatment regimen for Saudi Arabian patients infected with H. pylori is still unknown. We aimed to study the eradication rate of 10 days of quadruple therapy; bismuth subcitrate potassium 140 mg, metronidazole 125 mg, and tetracycline 125 mg for H. pylori infection in a Saudi population. PATIENTS AND METHODS This was a prospective, open-label, non-randomized controlled trial. Patients with H. pylori infection were diagnosed by upper gastrointestinal (GI) endoscopy and rapid urease test (RUT) or histology. Patients who tested positive were recruited. Eligible patients were prescribed a 10-day course of quadruple therapy and received three capsules 4 times daily for 10 days along with omeprazole 20 mg twice daily. H. pylori was considered eradicated if the urea breath test (UBT) was negative after 6 weeks of completing the treatment. RESULTS Ninety-two patients with H. pylori infection were recruited. Three patients withdrew from the trial and another seven patients lost follow-up. We analyzed 82 patient's data as per-protocol analysis, of whom 66 (80%) were naive to H. pylori treatment. Four patients had failed previous treatment with the sequential regimen and 12 patients had treatment with clarithromycin-based triple therapy. The post-treatment UBT for H. pylori infection was negative by per-protocol analysis in 72/82 patients (87.8%), and 72/92 (78.3%) by intention-to-treat analysis. There was no correlation between previous treatment failure and treatment response to the bismuth-based quadruple therapy (P value = 0.28). CONCLUSIONS Treatment with a bismuth-based quadruple therapy was effective in eradicating H. pylori infection in 78.3% of Saudi patients with an ITT analysis and in 87.8% as per-protocol analysis.
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Affiliation(s)
- Fahad Alsohaibani
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia,Address for correspondence: Dr. Fahad Alsohaibani, Department of Medicine MBC # 46, King Faisal Specialist Hospital and Research Center, P.O Box 3354, Riyadh - 11211, Saudi Arabia. E-mail:
| | - Mohammed Alquaiz
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Khalid Alkahtani
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Hamad Alashgar
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Musthafa Peedikayil
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Abdulrahman AlFadda
- Department of Medicine, Section of Gastroenterology, King Faisal Specialist Hospital and Research Center, Riyadh, Saudi Arabia
| | - Majid Almadi
- Department of Medicine, Division of Gastroenterology, King Saud University Medical City, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Bello AK, Borodo MM, Yakasai AM, Tukur AD. Helicobacter pylori antibiotic sensitivity pattern in dyspeptic patients in Kano, Nigeria. S Afr J Infect Dis 2019; 34:125. [PMID: 34485458 PMCID: PMC8378098 DOI: 10.4102/sajid.v34i1.125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2017] [Accepted: 08/02/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite the high prevalence of Helicobacter pylori infection in Nigeria, in the North-West there are no studies on the antibiotic sensitivity pattern of this organism. This study aims to determine the antibiotic sensitivity pattern of this bacterium as well as bridge the gap in knowledge. METHODS The study was cross-sectional in design. Questionnaires were administered in dyspeptic patients to obtain the relevant data. Two sets of gastric biopsy specimens were taken during upper gastrointestinal (GI) endoscopy. One set was sent to the histopathology laboratory for assessment and H. pylori identification, while the other set for culture was minced and plated on Columbia blood agar media (Oxoid Ltd, England) incubated at 37°C in an anaerobic jar containing CampyGen (Oxoid Ltd) to provide the required micro-aerobic environment. The disc diffusion method was used in determining the sensitivity pattern of isolates. Pre-treatment and post-treatment stool samples were collected from each patient for a H. pylori faecal antigen test to assess eradication rate. RESULTS The sensitivity of H. pylori to amoxicillin was 9.2%, and 100% for both clarithromycin and levofloxacin. Tetracycline, metronidazole, cefuroxime, tinidazole and ciprofloxacin were 100% resitant. The prevalence of H. pylori at histology was 81.7%. Only 101 subjects had a positive H. pylori stool antigen test. CONCLUSION This study showed a high amoxicillin resistance; however, there is high sensitivity (100%) to clarithromycin and levofloxacin. We recommended that levofloxacin be adopted in preference to amoxicillin as part of triple therapy in Nigeria.
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Affiliation(s)
- Ahmad K Bello
- Department of Internal Medicine, Faculty of Basic Clinical Sciences, Ahmadu Bello University, Ahmadu Bello University Teaching Hospital (ABATHU), Zaria, Nigeria
| | - Mohammad M Borodo
- Department of Internal Medicine, Faculty of Health Sciences, Bayero University Kano, Aminu Kano Teaching Hospital, Kano, Nigeria
| | - Ahmad M Yakasai
- Department of Infectious Diseases, Faculty of Clinical Sciences, Public Health and Diagnostic Institute, College of Medical Sciences, North-West University, Kano, Nigeria
| | - Abubakar D Tukur
- Department of Microbiology, Faculty of Allied Health Science, Aminu Kano Teaching Hospital, Bayero University, Kano, Nigeria
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12
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Eed EM, Hawash YA, Khalifa AS, Alsharif KF, Alghamdi SA, Saber T, Ismail KA, Shehab-Eldeen SA. Molecular diagnosis of Helicobacter pylori antibiotic resistance in the Taif region, Saudi Arabia. Microbiol Immunol 2019; 63:199-205. [PMID: 31045263 DOI: 10.1111/1348-0421.12686] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2019] [Accepted: 04/28/2019] [Indexed: 12/13/2022]
Abstract
Success in eradication of Helicobacter pylori is declining globally because H. pylori has developed resistance against most of the antibiotics proposed for eradication regimens, mainly through point mutations. The present study included 200 patients with dyspepsia attending Taif Hospital. Gastric biopsies were obtained during gastroscopy and subjected to rapid urease testing. Molecular methods were used to confirm diagnoses of H. pylori infection and to identify resistance gene variants of four antibiotics; namely, clarithromycin, metronidazole, fluoroquinolones and tetracycline (23S rRNA, gyrA, rdxA and 16S rRNA respectively). Of all investigated patients, Molecular diagnoses were made in 143 of all investigated patients; thus, the prevalence was .5%. The overall rate of resistance to clarithromycin among the H. pylori-positive patients was high (39.9%) and the rate of resistance significantly greater (48.2%) among the secondary resistance group, secondary resistance being defined as resistance as a result of previous exposure to the relevant antibiotic. The rate of resistance to fluoroquinolones was considered moderate; the difference in rate of resistance between the primary and secondary resistance groups (8.4% and 9.5%, respectively) was not significant Also, there was a low prevalence of both primary and the secondary tetracycline resistance in the study cohort. In contrast, the prevalence of metronidazole resistance was considered high with no significant difference between the two resistance groups. H. pylori showed an increased prevalence of resistance to all four of the commonly used therapeutic agents. Thus, eradication therapy should be based on the regional results of susceptibility testing. Moreover, treatment tailored according to individually determined H. pylori susceptibility may be a reasonable future goal.
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Affiliation(s)
- Emad M Eed
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Medical Microbiology and Immunology Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt
| | - Yousry A Hawash
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Molecular and Clinical Parasitology Department, National Liver Institute, Menoufia University, Al Menoufia, Egypt
| | - Amany S Khalifa
- Clinical Pathology Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt.,Medical Microbiology and Immunology Department, Faculty of Pharmacy, Taif University, Taif, Saudi Arabia
| | - Khalaf F Alsharif
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Saleh A Alghamdi
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia
| | - Taisir Saber
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Medical Microbiology and Immunology Department, Faculty of Medicine, Zagazig University, Zagazig, Egypt
| | - Khadiga A Ismail
- Department of Clinical Laboratory Sciences, College of Applied Medical Sciences, Taif University, Taif, Saudi Arabia.,Department of Parasitology, Faculty of Medicine, Ain-Shams University, Cairo, Egypt
| | - Somaia A Shehab-Eldeen
- Tropical Medicine Department, Faculty of Medicine, Menoufia University, Al Menoufia, Egypt
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13
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Aziz SA, Kamel FO. Knowledge, Attitude and Practice toward the Use of Antibiotics without Prescription in Jeddah, Saudi Arabia: A Cross-sectional Study. JOURNAL OF MEDICAL SCIENCES 2018. [DOI: 10.3923/jms.2019.45.50] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
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14
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Ram M. R, Teh X, Rajakumar T, Goh KL, Leow AHR, Poh BH, Mariappan V, Shankar EM, Loke MF, Vadivelu J. Polymorphisms in the host CYP2C19 gene and antibiotic-resistance attributes ofHelicobacter pyloriisolates influence the outcome of triple therapy. J Antimicrob Chemother 2018; 74:11-16. [DOI: 10.1093/jac/dky401] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2018] [Accepted: 09/05/2018] [Indexed: 12/11/2022] Open
Affiliation(s)
- Ravishankar Ram M.
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- Department of Molecular Biology and Genetics, Faculty of Science, University of South Bohemia, Branišovská 31, České Budějovice (Budweis), Czech Republic
| | - Xinsheng Teh
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Tamayanthi Rajakumar
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Khean Lee Goh
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Alex Hwong Ruey Leow
- Department of Medicine, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Bee Hoon Poh
- BP Diagnostic Centre Sdn Bhd, Ipoh, Perak, Malaysia
| | - Vanitha Mariappan
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
| | - Esaki M Shankar
- Division of Infection Biology and Medical Microbiology, Department of Life Sciences, Central University of Tamil Nadu (CUTN), Thiruvarur, India
| | - Mun Fai Loke
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
- School of Life Sciences & Chemical Technology, Ngee Ann Polytechnic, Singapore, Singapore
| | - Jamuna Vadivelu
- Department of Medical Microbiology, Faculty of Medicine, University of Malaya, Kuala Lumpur, Malaysia
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15
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Al-Shibani N, Hamed A, Labban N, Al-Kattan R, Al-Otaibi H, Alfadda S. Knowledge, attitude and practice of antibiotic use and misuse among adults in Riyadh, Saudi Arabia. Saudi Med J 2018; 38:1038-1044. [PMID: 28917069 PMCID: PMC5694638 DOI: 10.15537/smj.2017.10.19887] [Citation(s) in RCA: 22] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
Objectives: To assess the knowledge, attitude, and practice of antibiotics (ABs) use and misuse among adults living in Riyadh, Saudi Arabia. Methods: In this cross-sectional study, a self-administered questionnaire was distributed to participants from March 2016 to January 2017 in the outpatient department of King Khalid University Hospital and Dental Hospital, King Saud University, Riyadh, Saudi Arabia. The questionnaire was divided into 4 sections. The first and second section inquired regarding demographic details and knowledge of ABs. The third section assessed practice of ABs and the fourth section assessed attitude of participants towards ABs use. Questionnaires were hand delivered to respondents using convenience sampling. Statistical analysis using frequency distributions and knowledge responses of AB resistance for ‘yes’ and ‘no’ were associated with participant characteristics using Chi-square test. Results: A total of 1966 questionnaires were completed (response rate: 93.5%). Sixty-seven percent of the respondents were unaware of the meaning of ABs resistance. Sixty-seven percent of respondents were unaware of ABs being harmful for children’s teeth and 64.9% unaware of ABs that develop allergy and death. Twenty-four percent believed that ABs worked on viruses, 31% on cold and 21% can cure cough. Almost 51% used ABs without physician prescription while 37.5% obtained ABs directly from pharmacists without physician’s prescription. Almost 42% participants discontinued ABs on alleviation of symptoms. There was significant difference in knowledge response of AB resistance and source of AB use (p=0.026), reason of AB use (p=0.038) and discontinuation of ABs (p=0.041). Conclusion: Adults showed insufficient knowledge and understanding regarding the safe use of ABs consumption among the population.
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Affiliation(s)
- Nouf Al-Shibani
- Department of Periodontics and Community Dentistry, College of Dentistry, King Saud University, Riyadh, Kingdom of Saudi Arabia. E-mail.
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16
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Sequential versus concomitant therapy for treatment of Helicobacter pylori infection: an updated systematic review and meta-analysis. Eur J Clin Pharmacol 2017; 74:1-13. [DOI: 10.1007/s00228-017-2347-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2017] [Accepted: 09/29/2017] [Indexed: 02/06/2023]
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17
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Patnayak R, Jena A, Reddy VR. Helicobacter pylori: A Common Infection. J Family Med Prim Care 2015; 3:477. [PMID: 25657976 PMCID: PMC4311375 DOI: 10.4103/2249-4863.148160] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Affiliation(s)
- Rashmi Patnayak
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Venkat Rami Reddy
- Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
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18
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Ciprofloxacin-containing versus clarithromycin-containing sequential therapy for Helicobacter pylori eradication: A randomized trial. Indian J Gastroenterol 2015; 34:68-72. [PMID: 25721770 DOI: 10.1007/s12664-015-0535-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 01/04/2015] [Indexed: 02/06/2023]
Abstract
BACKGROUND AND STUDY AIMS Helicobacter pylori eradication rates with standard triple therapy have declined to unacceptable levels. This randomized trial aimed at evaluating the efficacy of a ciprofloxacin containing sequential regimen in the eradication of H. pylori-infected patients vs. a clarithromycin containing sequential therapy. METHODS A total of 212 patients were randomized into 14-day therapeutic schemes (106 patients per group): (1) clarithromycin-containing sequential therapy rabeprazole plus amoxicillin for 7 days, followed by rabeprazole plus clarithromycin plus metronidazole for 7 days, and (2) ciprofloxacin-containing sequential therapy using ciprofloxacin instead of clarithromycin. Eradication was confirmed by stool H. pylori antigen. Adverse effects and compliance were assessed by a questionnaire. RESULTS Per protocol cure rates were as follows: 87.6 % in the ciprofloxacin-containing sequential therapy and 76 % in the clarithromycin group. Intention-to-treat cure rates were as follows: 73.5 % for the ciprofloxacin group and 66 % for the clarithromycin group. No differences in compliance or adverse effects were demonstrated among treatments. CONCLUSION Ciprofloxacin-containing sequential therapy is more effective and equally safe compared to a clarithromycin-containing sequential therapy.
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Affiliation(s)
- Rashmi Patnayak
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. E-mail:
| | - Amitabh Jena
- Department of Surgical Oncology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Venkat R. Reddy
- Department of Surgical Gastroenterology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India
| | - Thota Asha
- Department of Pathology, Sri Venkateswara Institute of Medical Sciences, Tirupati, Andhra Pradesh, India. E-mail:
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Alvi A. In response to "Conclusive strategies for therapy and virotyping of Helicobacter pylori". Saudi J Gastroenterol 2014; 20:326. [PMID: 25384332 PMCID: PMC4196353 DOI: 10.4103/1319-3767.141701] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Affiliation(s)
- Ayesha Alvi
- Department of Genetics and Molecular Biology, Faculty of Applied Medical Sciences, Jazan University, Jazan, Kingdom of Saudi Arabia E-mail:
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21
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Abadi ATB, Mobarez AM. Conclusive strategies for therapy and virotyping of Helicobacter pylori. Saudi J Gastroenterol 2014; 20:325. [PMID: 25253371 PMCID: PMC4196352 DOI: 10.4103/1319-3767.141699] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Affiliation(s)
- Amin T. B. Abadi
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran,Department of Medical Microbiology, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Ashraf M. Mobarez
- Department of Bacteriology, Faculty of Medical Sciences, Tarbiat Modares University, Tehran, Iran
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