title: How antibiotic resistances could change Helicobacter pylori treatment: A matter of geography?
abstract: Therapeutic management of Helicobacter pylori (H. pylori) remains an unsolved issue. Indeed, no therapeutic regimen is able to cure the infection in all treated patients, and in many the infection persists despite the administration of several consecutive standard therapies. Although antibiotic resistance reports describe alarming results, the outcome of therapeutic regimens does not seem to parallel this scenario in most cases, since a successful performance is often reached in more than 80% of cases. However, the phenomenon of increasing antibiotic resistance is being closely studied, and the results show controversial aspects even in the same geographic area. For the continents of Europe, America, Asia, Africa, and Oceania, minimal and maximal values of resistance to the main antibiotics (clarithromycin, amoxicillin, metronidazole, and levofloxacin) feature wide ranges in different countries. The real enigma is therefore linked to the several different therapeutic regimens, which show results that often do not parallel the in vitro findings even in the same areas. A first aspect to be emphasized is that some regimens are limited by their use in very small geographic districts. Moreover, not all therapeutic trials have considered bacterial and host factors affecting the therapeutic outcome. The additional use of probiotics may help to reduce adverse events, but their therapeutic impact is doubtful. In conclusion, the "ideal therapy", paradoxically, appears to be a "utopia", despite the unprecedented volume of studies in the field and the real breakthrough in medical practice made by the discovery and treatment of H. pylori. The ample discrepancies observed in the different areas do not encourage the development of therapeutic guidelines that could be valid worldwide. On these bases, one of the main challenges for the future might be identifying a successful solution to overcome antibiotic resistances. In this context, geography must be considered a relevant matter.
authors.affiliation: Enzo Ierardi, Floriana Giorgio, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Division of Gastroenterology, Department of Emergency and Organ Transplantation, 70124 Bari, Italy.
authors.forename: Enzo
authors.initials: E
authors.lastname: Ierardi
authors.affiliation: Enzo Ierardi, Floriana Giorgio, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Division of Gastroenterology, Department of Emergency and Organ Transplantation, 70124 Bari, Italy.
authors.forename: Floriana
authors.initials: F
authors.lastname: Giorgio
authors.affiliation: Enzo Ierardi, Floriana Giorgio, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Division of Gastroenterology, Department of Emergency and Organ Transplantation, 70124 Bari, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Losurdo
authors.affiliation: Enzo Ierardi, Floriana Giorgio, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Division of Gastroenterology, Department of Emergency and Organ Transplantation, 70124 Bari, Italy.
authors.forename: Alfredo
authors.initials: A
authors.lastname: Di Leo
authors.affiliation: Enzo Ierardi, Floriana Giorgio, Giuseppe Losurdo, Alfredo Di Leo, Mariabeatrice Principi, Division of Gastroenterology, Department of Emergency and Organ Transplantation, 70124 Bari, Italy.
authors.forename: Mariabeatrice
authors.initials: M
authors.lastname: Principi
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D024881:Drug Resistance, Bacterial / Q000235:genetics; D005838:Genotype; D062306:Geography, Medical; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000235:genetics; D006801:Humans; D010641:Phenotype; D015995:Prevalence; D019936:Probiotics / Q000627:therapeutic use; D012307:Risk Factors; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents
keywords: Antibiotic resistance; Geography; Helicobacter pylori; Therapeutic outcome; Therapeutic regimens