Related Experiment Videos
[Helicobacter pylori infection and antimicrobial agents resistance]
1Service de médecine interne H, CHU de Nancy-hôpital central, 29, avenue de Lattre-de-Tassigny, 54035 Nancy, France. jd.dekorwin@chu-nancy.fr
Purpose:
Seven days triple therapies combining a proton pump inhibitor (PPI) and 2 antimicrobial agents (clarithromycin [C], amoxicillin [A], metronidazole [M]), are recommended for the treatment of Helicobacter pylori infection. The eradication failures have increased these last years, particularly in France (about 30%). They are essentially related to the development of antimicrobial agents resistance, mainly concerning macrolides and nitro-imidazoles.
Current Knowledge And Key Points:
Primary resistance to clarithromycin is variable, but reaching now about 10% throughout the world and about 20% in France. It reduces the eradication success rate at 25%. The secondary resistance is very high, contra-indicating the use of clarithromycin in second line regimens. Primary resistance to amoxicillin has recently appeared, but remains very low until now, less than 2%, as the tetracyclin (T) resistance. Primary resistance to metronidazole is 3 times higher than macrolides resistance, but its determination is less accurate. Metronidazole resistance reduces eradication rate of about 25%, leading to the use of metronidazole in second line therapy, in increasing the triple therapy duration at 14 days (PPI-A-M), or in combination with quadruple therapy (Bismuth-PPI-T-M). Other rescue-treatments are efficacious, based on ranitidine bismuth citrate combined regimens or on rifabutine (R) based regimens (PPI-A-R).
Future Prospects And Projects:
The recent knowledge of the mutations mainly responsible for H. pylori resistance to antimicrobial agents now allows the development of detection methods based on the study of bacterial DNA. These methods have been validated for clarithromycin and should favour in the near future the determination of resistance by the use of biopsy culture or directly on the gastric biopsy.
Insights
Helicobacter pylori treatment failures are rising due to antimicrobial resistance. New DNA-based methods can detect resistance, guiding better treatment strategies for H. pylori infection.
Area of Science:
- Microbiology
- Infectious Diseases
- Pharmacology
Background:
- Standard seven-day triple therapies for Helicobacter pylori infection, using a proton pump inhibitor (PPI) and two antimicrobials (clarithromycin, amoxicillin, metronidazole), are increasingly failing.
- Eradication failure rates, particularly in France, approach 30%, primarily driven by growing resistance to clarithromycin (macrolides) and metronidazole (nitro-imidazoles).
- Primary clarithromycin resistance is around 10% globally (20% in France), significantly reducing eradication success. Secondary resistance contraindicates its use in second-line treatments. Amoxicillin and tetracycline resistance remain low (<2%). Metronidazole resistance is higher and impacts eradication rates, necessitating longer or alternative therapies.
Purpose of the Study:
- To address the rising challenge of Helicobacter pylori treatment failures.
- To highlight the impact of antimicrobial resistance on H. pylori eradication efficacy.
- To explore advancements in detecting H. pylori resistance.
Main Methods:
- Review of current knowledge on antimicrobial resistance patterns in H. pylori.
- Analysis of factors contributing to eradication failures.
- Discussion of emerging diagnostic methods for resistance detection.
Main Results:
- Increasing primary and secondary resistance to key antibiotics like clarithromycin and metronidazole is a major cause of H. pylori treatment failure.
- Resistance significantly reduces the effectiveness of standard triple therapies, necessitating modified or rescue regimens.
- Novel diagnostic approaches based on bacterial DNA analysis are being developed.
Conclusions:
- Understanding the genetic basis of H. pylori resistance is crucial for developing effective diagnostic tools.
- DNA-based detection methods for clarithromycin resistance have been validated.
- Future strategies will likely involve direct detection of resistance from gastric biopsies, improving personalized H. pylori treatment.