DCGI requested to make Bismuth subcitrate / salicylate-based therapy for H Pylori Available in India

 Resistance to antibiotics for H pylori has more than doubled in 20 years, new research presented at UEG Week Barcelona 2019 has shown.

The study analysed 1,232 patients from 18 countries across Europe, investigated resistance to antibiotics taken for Helicobacter pylori.

Resistance to clarithromycin, had increased from 9.9% in 1998 to 21.6% last year, with increases in resistance also seen for levofloxacin and metronidazole.

With resistance rates to clarithromycin increasing at an alarming rate of nearly 1% per year, treatment options for H. pylori will become progressively limited and ineffective.

  1. pylori is one of the most common bacterial infections in humans and is estimated to be present in one-half of the world’s population.

In 2017, the World Health Organisation identified clarithromycin-resistant H. pylori as a high priority bacterium for antibiotic research and development.

The survey also found that the rates of primary clarithromycin resistance in H. pylori were highest in Southern Italy (39.9%), Croatia (34.6) and Greece (30%), aligning with previous reports that predict that both Italy and Greece will have the highest number of deaths due to antimicrobial resistance amongst EU members by 20507.

The rate of ‘primary’ clarithromycin resistance in H. pylori in Europe in 2018 (%) found in the study was:

  • Southern Italy: 36.9
    • Croatia: 34.6
    • Greece: 30.0
    • Poland: 28.5
    • Bulgaria: 26.9
    • Ireland: 25.6
    • Austria: 23.5
    • France: 22.5
    • Germany: 22.2
    • Portugal: 20.0
    • Belgium: 17.4
    • Spain: 17.1
    • Slovenia: 16.0
    • Lithuania: 13.0
    • Netherlands: 9.2
    • Norway: 8.9
    • Latvia: 6.8
    • Denmark: 5.0
    [Mário Dinis-Ribeiro, President of the European Society of Gastrointestinal Endoscopy]

Bismuth subcitrate / salicylate-based therapy is the first line for treatment of H Pylori in India because of clarithromycin resistance.


However, it is not being manufactured in India currently. It was being manufactured earlier a few years back.


It would be a great service to the patients if the DCGI or the Indian Government ensures that the Indian companies manufacture it.

Dr Vineet Ahuja is Professor GI at AIIMS Delhi.