Optimizing Helicobacter pylori Treatment: An Updated Review of Empirical and Susceptibility Test-Based Treatments

Abstract

As the rate of discovery of drug-resistant Helicobacter pylori cases increases worldwide, the relevant societies have updated their guidelines for primary eradication regimens. A promising strategy against drug-resistant H. pylori is tailored therapy based on the results of an antibiotic susceptibility test; however, it is difficult to apply this strategy to all cases. Although culture-based antibiotic susceptibility tests can assess resistance to any antimicrobial agent, their greatest disadvantage is the time required to draw a conclusion. In contrast, molecular-based methods, such as polymerase chain reaction, can rapidly determine the presence of resistance, although a single test can only test for one type of antimicrobial agent. Additionally, the limited availability of facilities for molecular-based methods has hindered their widespread use. Therefore, low-cost, minimally invasive, simple, and effective primary regimens are needed. Several studies have compared the efficacy of the latest primary eradication regimens against that of tailored therapies, and their results have shaped guidelines. This article reviews the latest research on empirical and tailored treatments for H. pylori infections. Evidence for the superiority of tailored therapy over empirical therapy is still limited and varies by region and treatment regimen. A network meta-analysis comparing different empirical treatment regimens showed that vonoprazan triple therapy provides a superior eradication effect. Recently, favorable results towards vonoprazan dual therapy have been reported, as it reached eradication levels similar to those of vonoprazan triple therapy. Both vonoprazan dual therapy and tailored therapy based on antibiotic susceptibility tests could contribute to future treatment strategies.

Helicobacter pylori Antibiotic Resistance: Molecular Basis and Diagnostic Methods

“…Therefore, its implementation into clinical practice remains problematic. It is possible that in the future, with the reduction in the cost of analysis, NGS would be implemented into routine clinical practice [32].…”

Current and Future Perspectives on the Management of Helicobacter pylori: A Narrative Review

“…The two main ways to perform AST are culture-based and molecular methods, such as polymerase chain reaction (PCR) or next-generation sequencing [ 63 ]. Each technique comes with unique considerations.…”

Genetic Markers of <em>Helicobacter pylori </em>Antibiotic Resistance in Moscow

“…According to literature data, clarithromycin resistance is mainly caused by three-point mutations in the 23S rRNA gene: A2142G, A2142C, and A2143G, encoding peptidyl transferase in the V domain of the gene, which is the main target of macrolides. Point mutations in this region disrupt the binding of macrolides to bacterial cell ribosomes, leading to resistance formation [18][19][20][21][22][23][24]. 23S rRNA is found in the 50S subunit of prokaryotic ribosomes and is characterized by gene redundancy.…”

“…Resistance to fluoroquinolones is caused by mutations in the gyrA gene, which encodes the A subunit of bacterial DNA gyrase, mainly at codons 87, 88, and 91 of the gyrA gene [18][19][20][21][22][23][24]. In different regions, the frequency and nature of mutations that confer H. pylori resistance can differ.…”