Tailored therapy based on antibiotic resistance

초록

The cure rates of Helicobacter pylori (H. pylori) eradication therapy using a proton pump inhibitor (PPI) and antimicrobial agents such as amoxicillin (AMX), clarithromycin (CLR), or metronidazole (MTZ) are mainly infuenced by bacterial susceptibility to antimicrobial agents. Recently, the eradication rates have gradually decreased because of the increased prevalence of H. pylori strains resistant to antimicrobial agents. As the prevalence of antibiotic (e.g., CLR, MTZ, tetracycline, AMX, and fuoroquinolone) resistance was different in the worldwide, local surveillance of antibiotic resistance assessed by H. pylori culture and antimicrobial susceptibility testing is warranted to guide clinicians in their choice of therapy. The standard phenotypic testing methods and the molecular testing methods have shown to achieve at least 90% success rate, especially in the era of alarmingly high antibiotic resistance of H. pylori. The standard phenotypic methods require the successful culture of live H. pylori isolates from gastric biopsies and are indeed time-consuming. However, it is currently the only way to test the susceptibility of H. pylori isolates to all the commonly used anti-H. pylori antibiotics. Compared to the standard phenotypic methods, the molecular testing method does not require successful H. pylori culture and therefore is much more rapid and convenient for clinical use. However, this test is only suitable for detecting CLR and levofoxacin susceptibility profles in H. pylori. © Springer Nature Singapore Pte Ltd. 2023. All rights reserved.

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