title: Different Antibiotic No Culture Eradicating (DANCE) strategy: an easy way to manage H. pylori eradication.
abstract: Treatment of Helicobacter pylori infection is becoming a very relevant problem especially in industrialized Countries. Although different therapeutic regimens are currently available, treatment failure remains a growing problem in daily medical practice. Several factors could play a role in the eradication failure, but the most relevant are antibiotic resistance and patient's compliance. While Helicobacter pylori resistance to amoxicillin is rare, clarithromycin and metronidazole resistance varies significantly from close to zero up to 25%. However, metronidazole in vitro resistance exhibits a lower impact on eradication success because resistance in vitro does not reflect that in vivo. Specific guidelines have then been published, mostly based on antibiotic resistance among different geographic areas. Basically, first-line and second-line regimens have been well defined; concerning third-line treatment Maastricht III guidelines suggest to adopt a culture-based approach. Culture is, however, expensive, invasive and available only in few specialized centres. An alternative approach may be to use an empirical strategy, based on the avoidance of repeating similar eradicating schemes in the same patients during the course of different eradicating regimens. For this approach we propose the acronym DANCE (Different Antibiotic No Culture Eradicating) strategy. When correctly applied, this approach showed to reach successful eradication in up to 99.5% of Helicobacter pylori-positive patients.
authors: Internal Medicine, Catholic University of Rome, Italy.
authors: Davide
authors: D
authors: Roccarina
authors: Francesco
authors: F
authors: Franceschi
authors: Maria Assunta
authors: MA
authors: Zocco
authors: Matteo
authors: M
authors: Garcovich
authors: Giovanni
authors: G
authors: Gasbarrini
authors: Antonio
authors: A
authors: Gasbarrini
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000897:Anti-Ulcer Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D055118:Medication Adherence; D017410:Practice Guidelines as Topic; D017211:Treatment Failure
chemical_list: D000900:Anti-Bacterial Agents; D000897:Anti-Ulcer Agents