Biofilm demolition and antibiotic treatment to eradicate resistant Helicobacter pylori: a clinical trial.
OBJECTIVE
Helicobacter pylori attaches to gastric mucosa and grows as a biofilm. This constitutes protection from antimicrobial agents. We assessed the role of a pretreatment with n-acetylcysteine in destroying biofilm and overcoming H pylori antibiotic resistance.


METHODS
In an open-label, randomized controlled trial, 40 subjects with a history of at least 4 H pylori eradication failures were evaluated for biofilm presence, antibiotic susceptibility, and H pylori genotypes. Subjects were assigned randomly to receive (group A) or not (group B) n-acetylcysteine before a culture-guided antibiotic regimen. The primary end point was the H pylori eradication rate as assessed by (13)C-labeled urea breath testing.


RESULTS
H pylori was eradicated in 13 of 20 (both per-protocol and intention-to-treat analyses, 65%; 95% confidence interval, 44%-86%) group A participants and 4 of 20 (both per-protocol and intention-to-treat analyses, 20%; 95% confidence interval, 3%-37%) group B participants (P < .01). Biofilms persisted only in unsuccessfully treated participants. H pylori genotypes did not influence treatment outcome.


CONCLUSIONS
N-acetylcysteine pretreatment before a culture-guided antibiotic regimen is effective in overcoming H pylori antibiotic resistance.
Cammarota
Giovanni
G
Institute of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
Branca
Giovanna
G
Ardito
Fausta
F
Sanguinetti
Maurizio
M
Ianiro
Gianluca
G
Cianci
Rossella
R
Torelli
Riccardo
R
Masala
Giovanna
G
Gasbarrini
Antonio
A
Fadda
Giovanni
G
Landolfi
Raffaele
R
Gasbarrini
Giovanni
G
D000111:Acetylcysteine / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018441:Biofilms / Q000187:drug effects* / Q000254:growth & development; D001944:Breath Tests; D004359:Drug Therapy, Combination; D005100:Expectorants / Q000627:therapeutic use*; D005260:Female; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D014508:Urea / Q000032:analysis
D000900:Anti-Bacterial Agents; D005100:Expectorants; D014508:Urea; D000111:Acetylcysteine