Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection
Maria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss...
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| Format: | Article |
| Language: | English |
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Dove Medical Press
2017-07-01
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| Series: | Drug Design, Development and Therapy |
| Subjects: | |
| Online Access: | https://www.dovepress.com/antibiotic-susceptibility-heteroresistance-and-updated-treatment-strat-peer-reviewed-article-DDDT |
| _version_ | 1818061525911339008 |
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| author | Mascellino MT Porowska B De Angelis M Oliva A |
| author_facet | Mascellino MT Porowska B De Angelis M Oliva A |
| author_sort | Mascellino MT |
| collection | DOAJ |
| description | Maria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals. Keywords: eradication, biopsies, rescue |
| first_indexed | 2024-12-10T13:49:42Z |
| format | Article |
| id | doaj.art-6a638dc77007482885f879baa10e6b20 |
| institution | Directory Open Access Journal |
| issn | 1177-8881 |
| language | English |
| last_indexed | 2024-12-10T13:49:42Z |
| publishDate | 2017-07-01 |
| publisher | Dove Medical Press |
| record_format | Article |
| series | Drug Design, Development and Therapy |
| spelling | doaj.art-6a638dc77007482885f879baa10e6b202022-12-22T01:46:16ZengDove Medical PressDrug Design, Development and Therapy1177-88812017-07-01Volume 112209222033998Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infectionMascellino MTPorowska BDe Angelis MOliva AMaria Teresa Mascellino,1 Barbara Porowska,2 Massimiliano De Angelis,1 Alessandra Oliva1 1Department of Public Health and Infectious Diseases, 2Department of Cardio-Thoracic, Vascular, General Surgery and of Organ Transplants, Policlinico Umberto I, Rome, Italy Abstract: In this review, we discuss the problem of antibiotic resistance, heteroresistance, the utility of cultures and antibiotic susceptibility tests in Helicobacter pylori (Hp) eradication, as well as the updated treatment strategies for this infection. The prevalence of antibiotic resistance is increasing all over the world, especially for metronidazole and clarithromycin, because of their heavy use in some geographical areas. Heteroresistance (simultaneous presence of both susceptible and resistant strains in different sites of a single stomach) is another important issue, as an isolate could be mistakenly considered susceptible if a single biopsy is used for antimicrobial tests. We also examined literature data regarding eradication success rates of culture-guided and empiric therapies. The empiric therapy and the one based on susceptibility testing, in Hp eradication, may depend on several factors such as concomitant diseases, the number of previous antibiotic treatments, differences in bacterial virulence in individuals with positive or negative cultures, together with local antibiotic resistance patterns in real-world settings. Updated treatment strategies in Hp infection presented in the guidelines of the Toronto Consensus Group (2016) are reported. These suggest to prolong eradication therapy up to 14 days, replacing the old triple therapy with a quadruple therapy based on proton pump inhibitor (PPI), bismuth, metronidazole, and tetracycline for most of the patients, or as an alternative quadruple therapy without bismuth, based on the use of PPI, amoxicillin, metronidazole, and clarithromycin. The new drug vonoprazan, a first-in-class potassium-competitive acid blocker recently approved in Japan, is also considered to be a promising solution for Hp eradication, even for clarithromycin-resistant strains. Furthermore, there is growing interest in finding new therapeutic strategies, such as the development of vaccines or the use of natural resources, including probiotics, plants, or nutraceuticals. Keywords: eradication, biopsies, rescuehttps://www.dovepress.com/antibiotic-susceptibility-heteroresistance-and-updated-treatment-strat-peer-reviewed-article-DDDTHelicobacter pylori infectionantibiotic resistancetreatment failureheteroresistanceupdated therapies |
| spellingShingle | Mascellino MT Porowska B De Angelis M Oliva A Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection Drug Design, Development and Therapy Helicobacter pylori infection antibiotic resistance treatment failure heteroresistance updated therapies |
| title | Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection |
| title_full | Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection |
| title_fullStr | Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection |
| title_full_unstemmed | Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection |
| title_short | Antibiotic susceptibility, heteroresistance, and updated treatment strategies in Helicobacter pylori infection |
| title_sort | antibiotic susceptibility heteroresistance and updated treatment strategies in helicobacter pylori infection |
| topic | Helicobacter pylori infection antibiotic resistance treatment failure heteroresistance updated therapies |
| url | https://www.dovepress.com/antibiotic-susceptibility-heteroresistance-and-updated-treatment-strat-peer-reviewed-article-DDDT |
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