Tailored therapy based on antibiotic resistance

The cure rates of Helicobacter pylori (H. pylori) eradication therapy using a proton pump inhibitor (PPI) and antimicrobial agents such as amoxicillin (AMX), clarithromycin (CAM), and metronidazole (MNZ) are mainly influenced by bacterial susceptibility to antimicrobial agents, and the eradication rates have gradually decreased because of the increased prevalence of H. pylori strains resistant to antimicrobial agents. The prevalence of antibiotic (e.g., CAM, MNZ, tetracycline, AMX, and furazolidone) resistance varies among different countries; it appears to be partly determined by geographical factors. Since the worldwide increase in the rate of antibiotic resistance represents a problem of relevance, local surveillance of antibiotic resistance assessed by H. pylori culture and antimicrobial susceptibility testing is warranted to guide clinicians in their choice of therapy. Recently developed molecular tests offer an attractive alternative to culture and allow for the rapid molecular genetic identification of H. pylori and resistance-associated mutations directly from biopsy samples or bacterial culture material. In the future, tailored therapy based on use of these techniques may allow for successful therapy for H. pylori infection.