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2017 ; 23
(16
): 2854-2869
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gab.com Text
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Importance of antimicrobial susceptibility testing for the management of
eradication in Helicobacter pylori infection
#MMPMID28522904
Arslan N
; Y?lmaz Ö
; Demiray-Gürbüz E
World J Gastroenterol
2017[Apr]; 23
(16
): 2854-2869
PMID28522904
show ga
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.
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