Usefulness of antimicrobial susceptibility in the eradication of Helicobacter pylori

Cosme, Ángel; Montes, Milagrosa; Martos, Maider; Gil, Inés; Mendarte, Usua; Salicio, Y.; Piñeiro, Luis; Recasens, Mireia; Ibarra, Begoña; Sarasqueta, Cristina; Bujanda, Luís

doi:10.1111/j.1469-0691.2012.03844.x

Cited by 50 publications

(48 citation statements)

References 18 publications

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“…Governments would rather offer and pay for susceptibility testing than to retest and retreat a significant proportion of the population. In the presence of increasing resistance a susceptibility-based strategy has been shown to be cost effective [39]. Clearly, we clinicians must take the full blame for using excuses rather than attempting to solve the problem.…”

Section: One Solutionmentioning

confidence: 99%

Helicobacter pyloritherapy: a paradigm shift

Graham

Dore

2016

Expert Review of Anti-infective Therapy

103

124

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SUMMARY Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.

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Section: One Solutionmentioning

confidence: 99%

Helicobacter pyloritherapy: a paradigm shift

Graham

Dore

2016

Expert Review of Anti-infective Therapy

103

124

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“…These methods have disadvantages, e.g ., results are not obtained until 48-96 h after inoculation of the agar plates[19,23,24]. The detection of H. pylori and the determination of antimicrobial resistance are very important before treatment if the clarithromycin resistance rates in the area have reached 15%-20%[25,26] or the metronidazole resistance rates have reached 40%[26]. When bacterial culture cannot be performed in a routine manner, molecular methods are alternative approaches for determining antimicrobial resistance[23].…”

Section: Introductionmentioning

confidence: 99%

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Arslan

Yılmaz

Demiray-Gürbüz

2017

WJG

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The management of Helicobacter pylori (H. pylori) infection treatment differs from the common treatment protocol for other infectious diseases. Because culture- or molecular-guided approaches face several practical issues, such as the invasive procedures required to obtain gastric biopsy specimens and the lack of availability of routine laboratory testing in some places, H. pylori treatment includes the administration of two or three empirically selected antibiotics combined with a proton pump inhibitor rather than evidence-based eradication treatment. The efficacy of empirical therapy is decreasing, mostly due to increasing multiple resistance. Multiresistance to levofloxacin, clarithromycin, and metronidazole, which are commonly used in empirical treatments, appears to have increased in many countries. Mutations play a primary role in the antimicrobial resistance of H. pylori, but many different mechanisms can be involved in the development of antibiotic resistance. Determining and understanding these possible mechanisms might allow the development of new methods for the detection of H. pylori and the determination of antimicrobial resistance. A treatment based on the detection of antimicrobial resistance is usually more effective than empirical treatment. Nevertheless, such an approach before treatment is still not recommended in the Maastricht guidelines due to the difficulty associated with the routine application of available culture- or molecular-based susceptibility tests, which are usually administered in cases of treatment failure. The management of first and rescue treatments requires further research due to the steadily increase in antimicrobial resistance.

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“…The superiority of a tailored therapy as a second-line approach was also demonstrated by a South-Korean prospective study (29). Furthermore, it may also prove to be a cost-effective strategy in high clarithromycin resistance regions (30,31).…”

Section: Discussionmentioning

confidence: 82%

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

et al. 2017

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Background: Helicobacter pylori eradication rates with standard triple therapy in many countries are clinically unacceptable. Fluoroquinolone resistance is increasing and jeopardizing secondline regimens. There is a growing need for an effective strategy in patients who failed previous therapies.Methods: This is a single-center, non-randomized clinical study conducted in the central region of Portugal. Sixty-four patients were included with a positive 13 C-urea breath test (UBT) or histology for H. pylori, and at least one failed eradication attempt. The patient cohort included 71.7% of females with a median of age of 52 (range 23-87). They were treated with a twelve-day regimen consisting of a proton-pump inhibitor (PPI) bid, amoxicillin at 1,000 mg 12/12h and levofloxacin at 500 mg bid during the first seven days, followed by PPI bid, clarithromycin at 500 mg 12/12 h and either tinidazole or metronidazole at 500 mg bid/tid for five days. Eradication was assessed by UBT. The local Ethics Committee approved this study.Results: Eradication therapy was prescribed due to dyspepsia (66.7%), peptic ulcer (10%) and thrombocytopenia (8.3%). The median number of failed therapies was one (range 1-4). The eradication rate was 64.6% according to an intention-to-treat analysis (95% CI: 53-77%), and 70% by the per-protocol analysis (95% CI: 58-82%). Age, smoking, indication for eradication, previous therapies and the use of a second-generation or full-dose PPI did not affect success rates.Conclusions: Even though treatment with four antibiotics was used, this "reinforced" therapy achieved suboptimal results. This fact highlights the lack of effective H. pylori antimicrobials and suggests that second-line treatment in our region should be prescribed according to susceptibility testing.

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Usefulness of antimicrobial susceptibility in the eradication of Helicobacter pylori

Cited by 50 publications

References 18 publications

Helicobacter pyloritherapy: a paradigm shift

Helicobacter pyloritherapy: a paradigm shift

Importance of antimicrobial susceptibility testing for the management of eradication inHelicobacter pyloriinfection

Twelve-day quintuple regime containing four antibiotics as a rescue therapy for Helicobacter pylori eradication in the central region of Portugal

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