Culture-guided treatment approach for Helicobacter pylori infection: Review of the literature

Abstract

The progressive loss of efficacy of standard eradication therapies has made the treatment of Helicobacter pylori (H. pylori) more challenging than ever. Endoscopic-guided antibiotic susceptibility testing had previously been suggested to guide treatment after failure of second-line therapies. However, its role has expanded over the years, in accordance with the current Maastricht Guidelines. Several authors have dealt with this topic, developing both efficacy trials and cost-effectiveness trials against resistant H. pylori infections as well as infections in naïve patients. However, results are not homogeneous enough to provide definite advice, because antibiotic resistance is not the only reason for treatment failure. Moreover, the culture-guided approach is surrounded by many practical issues, such as the availability of both endoscopy units and microbiology laboratories, and the need for a standard of quality that cannot be satisfied everywhere. Finally, pre-treatment susceptibility testing should be part - and not the only weapon - of a targeted, personalized strategy to overcome H. pylori infection.

Keywords: Helicobacter pylori; Antibiotic resistance; Antibiotic susceptibility testing; Culture-guided approach; Personalized therapy

Core tip: Eradication of Helicobacter pylori (H. pylori) has become hard to achieve, mainly because of the decrease of standard therapies and the rise of antibiotic resistance. The role of antibiotic susceptibility testing in the management of H. pylori infection is therefore becoming greater than in the past. This paper provides an overview of data in the literature about the culture-guided approach against H. pylori infection.