Efficacy and tolerability of culture-guided treatment for Helicobacter pylori infection

Abstract

Third-line culture-guided treatment often fails to eradicate H. pylori infection. We need to find factors other than in-vitro antibiotic resistance to explain these suboptimal results.

Rifabutin-Based Rescue Therapy for Helicobacter pylori Eradication: A Long-Term Prospective Study in a Large Cohort of Difficult-to-Treat Patients

“…The utility of H. pylori culture, with antibiotic susceptibility testing, remains of high importance to define a tailored therapy [5]. However, culture is not always available on a routine basis [12]. On the other hand, it is not helpful to repeat any of the unsuccessful antibiotic treatment schemes already used by the patients [13].…”

Treatment of Helicobacter pylori infection in 2018

“…Multidrug (>3) resistance rates have been found in 15%‐31% of patients undergoing third‐line therapy . Age >50 years was the only discerning factor associated with resistance to three or more antibiotics, most likely related to lifetime exposure . However, culture‐guided first‐line treatment is seldom.…”

Current Status of the Third-LineHelicobacter pyloriEradication

“…Susceptibility testing-guided treatment does not always guarantee successful eradication, and there have been mixed results for the effectiveness of this treatment [ 15 , 26 ]. Third-line susceptibility testing-guided treatment often fails to eradicate H. pylori infection indicating that this test does not reflect in vivo susceptibility perfectly, and various factors are involved other than in vitro antibiotic resistance [ 27 ]. The possible factors include microorganism-related factors (high bacterial load and biofilm of H. pylori ), host-related factors (poor compliance to eradication regimen, smoking, cytochrome P450 2C19 genetic polymorphism, and impaired mucosal immunity), or treatment-related factors (inadequate dosage or duration of therapy and gastric acidity) [ 22 , 27 , 28 ].…”

“…Third-line susceptibility testing-guided treatment often fails to eradicate H. pylori infection indicating that this test does not reflect in vivo susceptibility perfectly, and various factors are involved other than in vitro antibiotic resistance [ 27 ]. The possible factors include microorganism-related factors (high bacterial load and biofilm of H. pylori ), host-related factors (poor compliance to eradication regimen, smoking, cytochrome P450 2C19 genetic polymorphism, and impaired mucosal immunity), or treatment-related factors (inadequate dosage or duration of therapy and gastric acidity) [ 22 , 27 , 28 ]. Poor adherence was reemphasized as an important cause of eradication failure after 1st-line and 2nd-line treatments [ 29 ], and extending the duration of quinolone-containing rescue therapy showed increasing eradication rate in a recent study [ 30 ].…”

“…Infection with multiple strains other than H. pylori is another possible reason [ 31 , 32 ]; more than 2 strains were cultured in 65% of patients, and the antibiotic susceptibility profile among the different strains was consistent only in 61.1% of patients in a Korean study [ 32 ]. Therefore, molecular susceptibility testing may better represent the in vitro antibiotic resistance profile, although comparative efficacy has not been proven [ 27 , 33 ]. Moreover, the cost-effectiveness of a culture with susceptibility testing to determine the 3rd-line H. pylori eradication regimen has not been determined [ 2 , 15 ].…”