Culture-guided treatment approach for Helicobacter pylori infection: review of the literature.
The progressive loss of efficacy of standard eradication therapies has made the treatment of Helicobacter pylori (H. pylori) more challenging than ever. Endoscopic-guided antibiotic susceptibility testing had previously been suggested to guide treatment after failure of second-line therapies. However, its role has expanded over the years, in accordance with the current Maastricht Guidelines. Several authors have dealt with this topic, developing both efficacy trials and cost-effectiveness trials against resistant H. pylori infections as well as infections in naïve patients. However, results are not homogeneous enough to provide definite advice, because antibiotic resistance is not the only reason for treatment failure. Moreover, the culture-guided approach is surrounded by many practical issues, such as the availability of both endoscopy units and microbiology laboratories, and the need for a standard of quality that cannot be satisfied everywhere. Finally, pre-treatment susceptibility testing should be part - and not the only weapon - of a targeted, personalized strategy to overcome H. pylori infection.
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Giovanni
G
Cammarota
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Gianluca
G
Ianiro
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Stefano
S
Bibbò
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Teresa Antonella
TA
Di Rienzo
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Luca
L
Masucci
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Maurizio
M
Sanguinetti
Giovanni Cammarota, Gianluca Ianiro, Stefano Bibbò, Teresa Antonella Di Rienzo, Antonio Gasbarrini, Division of Internal Medicine and Gastroenterology, Department of Internal Medicine, A Gemelli University Hospital, 00168 Rome, Italy.
Antonio
A
Gasbarrini
D000900:Anti-Bacterial Agents / Q000191:economics / Q000627:therapeutic use*; D003362:Cost-Benefit Analysis; D016527:Drug Costs; D024881:Drug Resistance, Bacterial; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000191:economics / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D008826:Microbial Sensitivity Tests / Q000191:economics; D018579:Patient Selection; D057285:Precision Medicine; D011237:Predictive Value of Tests; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents
Antibiotic resistance; Antibiotic susceptibility testing; Culture-guided approach; Helicobacter pylori; Personalized therapy