Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients
<i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication fails in a definite amount of patients despite one or more therapeutic attempts. Curing these patients is progressively more difficult, due to development of antibiotic resistance. Current guidelines suggest testing an...
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| Format: | Article |
| Language: | English |
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MDPI AG
2020-03-01
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| Series: | Antibiotics |
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| Online Access: | https://www.mdpi.com/2079-6382/9/3/121 |
| _version_ | 1819092517035966464 |
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| author | Saracino I.M. Pavoni M. Zullo A. Fiorini G. Saccomanno L. Lazzarotto T. Cavallo R. Antonelli G. Vaira D. |
| author_facet | Saracino I.M. Pavoni M. Zullo A. Fiorini G. Saccomanno L. Lazzarotto T. Cavallo R. Antonelli G. Vaira D. |
| author_sort | Saracino I.M. |
| collection | DOAJ |
| description | <i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication fails in a definite amount of patients despite one or more therapeutic attempts. Curing these patients is progressively more difficult, due to development of antibiotic resistance. Current guidelines suggest testing antibiotic susceptibility in <i>H. pylori</i> isolates following two therapeutic attempts. Aim: to evaluate the development of antibiotic resistance, MIC values trends and therapeutic outcomes in patients who failed at least one <i>H. pylori</i> eradication therapy. Methods: consecutive patients, referred to perform upper gastrointestinal endoscopy (UGIE) to our Unit from January 2009 to January 2019 following at least one therapeutic attempt were considered. Bacterial resistance towards clarithromycin, metronidazole and levofloxacin was tested. Patients received either a susceptibility-guided therapy or Pylera<sup>®</sup>. Results: a total of 1223 patients were <i>H. pylori</i> positive, and antibiotic susceptibility was available for 1037. The rate of antibiotic resistance and MIC values significantly increased paralleling the number of previous therapeutic attempts. Eradication rates of antibiogram-tailored therapies remained stable, except for the sequential therapy if used as a third line. As a rescue treatment, the Pylera<sup>®</sup> therapy achieved cure rates comparable to those of the other culture-guided therapies. Conclusions: A significant increase in the secondary resistance towards the three tested antibiotics was observed, both as rate and MIC values, in correlation with the number of therapy failures. These findings should be considered when administering an empirical second-line therapy. Pylera<sup>®</sup> therapy eradication rates are comparable to culture-tailored therapies. |
| first_indexed | 2024-12-21T22:56:52Z |
| format | Article |
| id | doaj.art-7c437be49ff84ccfb5d0689af076515d |
| institution | Directory Open Access Journal |
| issn | 2079-6382 |
| language | English |
| last_indexed | 2024-12-21T22:56:52Z |
| publishDate | 2020-03-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Antibiotics |
| spelling | doaj.art-7c437be49ff84ccfb5d0689af076515d2022-12-21T18:47:24ZengMDPI AGAntibiotics2079-63822020-03-019312110.3390/antibiotics9030121antibiotics9030121Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure PatientsSaracino I.M.0Pavoni M.1Zullo A.2Fiorini G.3Saccomanno L.4Lazzarotto T.5Cavallo R.6Antonelli G.7Vaira D.8Department of Surgical and Medical Sciences, University of Bologna, 40138 Bologna, ItalyDepartment of Surgical and Medical Sciences, University of Bologna, 40138 Bologna, ItalyGastroenterology Unit, ‘Nuovo Regina Margherita’ Hospital, 00153 Rome, ItalyDepartment of Surgical and Medical Sciences, University of Bologna, 40138 Bologna, ItalyDepartment of Surgical and Medical Sciences, University of Bologna, 40138 Bologna, ItalyDepartment of Experimental, Diagnostic and Specialty Medicine, University of Bologna, 40138 Bologna, ItalyMicrobiology and Virology Unit, University Hospital Città Della Salute e Della Scienza di Torino, 10126 Turin, ItalyDepartment of Molecular Medicine, Sapienza University of Rome, 00185 Rome, ItalyDepartment of Surgical and Medical Sciences, University of Bologna, 40138 Bologna, Italy<i>Helicobacter pylori</i> (<i>H. pylori</i>) eradication fails in a definite amount of patients despite one or more therapeutic attempts. Curing these patients is progressively more difficult, due to development of antibiotic resistance. Current guidelines suggest testing antibiotic susceptibility in <i>H. pylori</i> isolates following two therapeutic attempts. Aim: to evaluate the development of antibiotic resistance, MIC values trends and therapeutic outcomes in patients who failed at least one <i>H. pylori</i> eradication therapy. Methods: consecutive patients, referred to perform upper gastrointestinal endoscopy (UGIE) to our Unit from January 2009 to January 2019 following at least one therapeutic attempt were considered. Bacterial resistance towards clarithromycin, metronidazole and levofloxacin was tested. Patients received either a susceptibility-guided therapy or Pylera<sup>®</sup>. Results: a total of 1223 patients were <i>H. pylori</i> positive, and antibiotic susceptibility was available for 1037. The rate of antibiotic resistance and MIC values significantly increased paralleling the number of previous therapeutic attempts. Eradication rates of antibiogram-tailored therapies remained stable, except for the sequential therapy if used as a third line. As a rescue treatment, the Pylera<sup>®</sup> therapy achieved cure rates comparable to those of the other culture-guided therapies. Conclusions: A significant increase in the secondary resistance towards the three tested antibiotics was observed, both as rate and MIC values, in correlation with the number of therapy failures. These findings should be considered when administering an empirical second-line therapy. Pylera<sup>®</sup> therapy eradication rates are comparable to culture-tailored therapies.https://www.mdpi.com/2079-6382/9/3/121<i>h. pylori</i>non-naïve patientsantibiotic resistanceantibiotic susceptibility testrescue therapies |
| spellingShingle | Saracino I.M. Pavoni M. Zullo A. Fiorini G. Saccomanno L. Lazzarotto T. Cavallo R. Antonelli G. Vaira D. Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients Antibiotics <i>h. pylori</i> non-naïve patients antibiotic resistance antibiotic susceptibility test rescue therapies |
| title | Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients |
| title_full | Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients |
| title_fullStr | Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients |
| title_full_unstemmed | Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients |
| title_short | Antibiotic Resistance and Therapy Outcome in <i>H. pylori</i> Eradication Failure Patients |
| title_sort | antibiotic resistance and therapy outcome in i h pylori i eradication failure patients |
| topic | <i>h. pylori</i> non-naïve patients antibiotic resistance antibiotic susceptibility test rescue therapies |
| url | https://www.mdpi.com/2079-6382/9/3/121 |
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