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

Abstract

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.

Molecular Assessment of Resistance to Clarithromycin in Helicobacter pylori Strains Isolated from Patients with Dyspepsia by Fluorescent In Situ Hybridization in the Center of Iran

“…Phenotypic assays of determining antibiotic susceptibility including gradient diffusion susceptibility testing (E-test) and the agar dilution method are time-consuming, expensive, and not routine [13]. Therefore, molecular-based techniques such as PCR-restriction fragment length polymorphism (RFLP), real-time PCR, and fluorescence in situ hybridization (FISH) are appropriate alternatives to the phenotypic methods and can also detect point mutations associated with the antibiotic resistance.…”

“…Therefore, molecular-based techniques such as PCR-restriction fragment length polymorphism (RFLP), real-time PCR, and fluorescence in situ hybridization (FISH) are appropriate alternatives to the phenotypic methods and can also detect point mutations associated with the antibiotic resistance. FISH is a new technology based on fluorescently labeled DNA probes that hybridize with specific rRNA sequences of microorganisms and can identify H. pylori and resistance to clarithromycin in formalin-fixed paraffin-embedded tissue sections or cultured H. pylori colonies [13,14].…”

Surveillance of the Antimicrobial Resistance Rates of <b><i>Helicobacter pylori</i></b> Ten Years Later in the Western Central Region, Colombia

“…Helicobacter pylori has been associated with the development of multiple gastrointestinal diseases such as dyspepsia, peptic ulcer, chronic gastritis, MALT gastric lymphoma, and gastric cancer [1]. H. pylori infections are treated with different antimicrobials such as clarithromycin, metronidazole, amoxicillin, tetracycline, ciprofloxacin, levofloxacin, moxifloxacin, azithromycin, erythromycin, furazolidone, and nitrofurantoin [2][3][4][5], which are combined with a proton pump inhibitor (PPI) to increase their absorption in the stomach of the patient [5,6]. In Colombia, infection eradication therapy is empirical, in which the first-line treatment is the clarithromycin-based standard triple therapy (clarithromycin, amoxicillin and PPIs), agreeing to national and international guidelines [7][8][9].…”

“…In Colombia, infection eradication therapy is empirical, in which the first-line treatment is the clarithromycin-based standard triple therapy (clarithromycin, amoxicillin and PPIs), agreeing to national and international guidelines [7][8][9]. Resistance rates have increased in many countries, which warrant a continuous study of the H. pylori resistance rates worldwide and regionally [6].…”

Helicobacter pylori Mutations Detected by Next-Generation Sequencing in Formalin-Fixed, Paraffin-Embedded Gastric Biopsy Specimens Are Associated with Treatment Failure

“…Therefore, it is suggested to identify the H. pylori strains that are likely to fail empirical therapy and subsequently to choose a personalized therapeutic regimen with high likelihood of successful eradication. Several studies have reported that a treatment based on antimicrobial susceptibility testing is more effective than empirical treatment (15)(16)(17).…”