Question

Helicobacter pylori Infection: ACG Updates Treatment Recommendations

1. Why might eradication treatments fail when it comes to clearing H. pylori infections?
2. How might antibiotic susceptibility testing be used to circumvent treatment failure?

Answer 1

Helicobacter pylorie infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. It also have role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low dose aspirin or starting therapy with a non-steroidal anti inflammatory medication, unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura. Before prescribing the medication the doctor should be asked about the patient about the previous antibiotic exposure history .Because antibiotic resistance is the major cause of treatment failure.

Several factors contribute to treatment failure. These include patient compliance, bacterial resistance to antibiotics and treatment related issues. Treatment failure leads to development of bacterial resistance to metronidazole and clarithromycin.The standard first line treatment for helicobacter pylori infection has classically been triple therapy with clarithromycin and either metronidazole or amoxicillin.So retreatment can be undertaken with full dose of medications and a longer treatment duration or to choose different regimens to avoid the antibiotic previously used or to switch to proton pump inhibitor.

Wide spread use of antimicrobial drugs has resulted in a world wide increase in the prevalence of antibiotic resistance in H pylori.

There has been a significant decrease in the rate of triple therapy to treat H. Pylori infection, largely due to rapid increase in the prevalence of antibiotic resistant strains. Antibiotic resistance is the main reason for the failure of treatment. Standard culture based antimicrobial susceptibility testing and molecular methods provide key opportunities to tailor H. Pylori treatment based on the detection of antibiotic resistant strains, thereby enhancing eradication rates and decreasing H. Pylori -associated disease.