Need for standardization and harmonization of Helicobacter pylori antimicrobial susceptibility testing

Abstract

Background and aims As with other infectious diseases, Helicobacter pylori eradication regimens should be guided by susceptibility testing to achieve excellent success rate, especially in the era of high antibiotic resistance. However, susceptibility testing for H. pylori is rarely performed, which can be partly ascribed to the current lack of standardization of testing methods and the lack of unified consensus on the antibiotic resistance breakpoints. The aim of this review was to call for an international consensus on standardization and harmonization of H. pylori susceptibility testing. Methods We summarize and compare the advantages and disadvantages of four different phenotypic antimicrobial susceptibility testing (AST) methods (agar dilution, E‐test, disk diffusion, and broth microdilution) and the molecular susceptibility testing method for H. pylori. Results The standard phenotypic testing methods and the molecular testing methods have their own advantages and disadvantages. Compared to the standard phenotypic methods, the molecular testing method does not require successful H. pylori culture, and therefore, is much more rapid and convenient for clinical use. However, the currently available molecular testing method is only suitable for detecting clarithromycin and quinolone susceptibility profiles in H. pylori. Although the standard AST is time‐consuming, it is currently the only way to test the susceptibility of H. pylori to all the commonly used antibiotics. Conclusion To make H. pylori susceptibility testing become a clinical routine, an international consensus on standardization and harmonization of H. pylori AST is needed. Future efforts are needed for optimizing broth culture of H. pylori, and developing commercial AST plates for achieving high throughput and automated susceptibility testing for H. pylori.

The Efficacy and Safety of Vonoprazan and Amoxicillin Dual Therapy for Helicobacter pylori Infection: A Systematic Review and Network Meta-Analysis

“…Probiotics, in conjunction with recommended therapies, slightly increased the eradication rate and significantly decreased the adverse effects of antibiotics [46]. Susceptibility testing may guide the selection of the most effective treatment regimens and improve the eradication rate to exceed 90% [47]. It has been suggested that amoxicillin, clarithromycin, levofloxacin, and metronidazole should be routinely evaluated for H. pylori susceptibility [48,49].…”

Individualized diagnosis and eradication therapy for Helicobacter pylori infection based on gene detection of clarithromycin resistance in stool specimens: A systematic review and meta‐analysis

“…Phenotypic methods take at least 1–2 weeks to grow the fastidious microaerophilic bacterium 45 . Compared with the phenotypic method, the time cost of genotype testing of stool samples is very low, which ensures a shorter interval from diagnosis to upcoming individualized treatment.…”

“…Phenotypic methods take at least 1-2 weeks to grow the fastidious microaerophilic bacterium. 45 Compared with the phenotypic method, the time cost of genotype testing of stool samples is very low, which ensures a shorter interval from diagnosis to upcoming individualized treatment. Regarding the time interval to obtain resistance results, nested PCR takes 6.5 h from extraction to completing analysis; Genotype HelicoDR analysis 5 h; Amplidiag to the heterogeneity of the pooled sensitivity.…”

Jinghua Weikang capsule for helicobacter pylori eradication: A systematic review and meta-analysis with trial sequential analysis

“…However, few antibiotics have been developed successfully ( Tacconelli et al, 2018 ). Antimicrobial susceptibility testing for H. pylori is rarely performed partly due to the lack of standardized testing methods and consensus on antibiotic resistance breakpoints ( Li et al, 2022 ). The salvage therapy may be selected empirically after first-line therapy fails ( Chey et al, 2017 ).…”