title: Biofilm demolition and antibiotic treatment to eradicate resistant Helicobacter pylori: a clinical trial.
abstract: 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.
authors.affiliation: Institute of Internal Medicine, Catholic University of Medicine and Surgery, Rome, Italy. gcammarota@rm.unicatt.it
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cammarota
authors.forename: Giovanna
authors.initials: G
authors.lastname: Branca
authors.forename: Fausta
authors.initials: F
authors.lastname: Ardito
authors.forename: Maurizio
authors.initials: M
authors.lastname: Sanguinetti
authors.forename: Gianluca
authors.initials: G
authors.lastname: Ianiro
authors.forename: Rossella
authors.initials: R
authors.lastname: Cianci
authors.forename: Riccardo
authors.initials: R
authors.lastname: Torelli
authors.forename: Giovanna
authors.initials: G
authors.lastname: Masala
authors.forename: Antonio
authors.initials: A
authors.lastname: Gasbarrini
authors.forename: Giovanni
authors.initials: G
authors.lastname: Fadda
authors.forename: Raffaele
authors.initials: R
authors.lastname: Landolfi
authors.forename: Giovanni
authors.initials: G
authors.lastname: Gasbarrini
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D005100:Expectorants; D014508:Urea; D000111:Acetylcysteine