Clinical Implications of Helicobacter pylori Antibiotic Resistance in Italy: A Review of the Literature

Abstract

Helicobacter pylori (H. pylori) resistance to antibiotics has increased worldwide in recent decades, especially to clarithromycin. As a result, the World Health Organization (WHO) identified clarithromycin-resistant H. pylori as a “high priority” pathogen in 2017. As international guidelines recommend empirical therapy as first-line treatment, it is crucial to know local resistance rates and history of antibiotic use to determine the most appropriate first-line antibiotic treatment. Italy is one of the European countries with the highest prevalence of H. pylori infection and the highest percentage of antibiotic-resistant H. pylori. The aim of this review is to summarize all data on H. pylori antibiotic resistance in Italy in order to quantify the current rate and determine the most effective therapeutic approach. The study confirms an elevated level of resistance to clarithromycin, metronidazole, and levofloxacin in Italy. In addition, our results show a satisfactory eradication rate for a bismuth-based regimen when used as first- or second-line treatment. Naive patients are also successfully treated with clarithromycin-based quadruple therapies. Considering the good results of bismuth-based therapy as recovery therapy, this argues for the potential use of clarithromycin quadruple therapy as a first-line treatment.

Evolution of Helicobacter pylori Resistance to Antibiotics: A Topic of Increasing Concern

“…Important factors of H. pylori resistance evolution are the use of currently non-recommended regimens, such as triple clarithromycin-based therapy in regions with high (>15%) resistance to the agent [15,53], national antibiotic consumption, patient compliance and other host factors. High antibiotic consumption in Bulgaria can be associated with an increase in H. pylori resistance to all antibacterials, except tetracycline [36] (Figure 2).…”

Lactoferrin as a Component of Pharmaceutical Preparations: An Experimental Focus

“…Helicobacter pylori is a Gram-negative bacteria that inhabits the gastric mucosa and is a leading cause of chronic gastritis that eventually drives gastric ulcers, duodenal ulcers, and gastric adenocarcinoma [ 51 ]. Antibiotic treatment faces an increasing antibiotic resistance to first-line antibiotics including metronidazole, amoxicillin, and/or clarithromycin [ 51 ].…”

“…Helicobacter pylori is a Gram-negative bacteria that inhabits the gastric mucosa and is a leading cause of chronic gastritis that eventually drives gastric ulcers, duodenal ulcers, and gastric adenocarcinoma [ 51 ]. Antibiotic treatment faces an increasing antibiotic resistance to first-line antibiotics including metronidazole, amoxicillin, and/or clarithromycin [ 51 ]. An alternative product based on Lf loaded in biomimetic hydroxyapatite nanocrystals combined with the cell free supernatant from Lactobacillus paracasei , a probiotic with beneficial effects on gut health, has been proposed as a therapeutic for Helicobacter pylori infection [ 39 ].…”

The Interplay between Helicobacter pylori and Gut Microbiota in Non-Gastrointestinal Disorders: A Special Focus on Atherosclerosis

“…One aspect that must be considered when discussing the potential benefits of eradication therapy is the high incidence of antibiotic-resistant H. pylori strains in the general population [112]. In a recent review of the literature, Nista et al [113] observed for instance that in Italy the rate of antibiotic resistance is so high to even be worth considering clarithromycin quadruple therapy as a first-line treatment [113]. Antibiotic resistance is obviously a problem because of the difficulties it creates to eradicate infection [114], but also because patients have to then undergo multiple therapy lines, which creates problems in itself [115].…”