How widespread and convenient H. pylori susceptibility testing will result in pharmacological opportunities

ABSTRACT

Introduction

Until recently, antimicrobial therapy for Helicobacter pylori infections was almost universally empirical and based on a combination of expert opinion and local effectiveness. However, the new requirement that all therapeutic regimens reliably achieve high cure rates, the introduction of potassium competitive acid blockers and the availability of susceptibility testing many pharmacological opportunities particularly since all current therapies will require optimization. The ability to rapidly and inexpensively obtain H. pylori susceptibility data using stool samples makes obtaining susceptibility data practical and allows using susceptibility-based therapy routinely for both treatment-naïve patient and treatment failures.

Areas covered

We searched the literature from 1990 to current to identify studies reporting the effect of susceptibility testing on H. pylori treatment. This review examines how widespread and convenient H. pylori susceptibility testing will result in pharmacological opportunities. . Many pharmacological opportunities will emanate from a renewal of efforts to develop, propagate, confirm, and update best practices based on local and regional susceptibility/resistance patterns.

Expert opinion

The ability to evaluate treatment decisions and outcomes in susceptible infections and reliably achieve high cure rates should foster precise tailoring of pharmacologic therapy and should achieve the goals of high cure rates while preventing antimicrobial misuse and extending the useful life of current antibiotics.

KEYWORDS:

• Helicobacter pylori
• therapy
• susceptibility testing
• antimicrobial stewardship
• antibiotics

Article highlights

• Helicobacter pylori (H. pylori), an infectious cause of gastritis and gastric cancer, has become a major target for eradication.

• Until recently, clinicians have been faced with the unavailability of susceptibility testing in the face of worldwide increasing antimicrobial resistance. New ways of providing and using susceptibility data are necessary.

• The current universal availability of susceptibility testing and an increasing focus on restricting therapy to susceptibility-based optimized therapies portends a worldwide change in both the approach and the odds of successful therapy of H. pylori infections.

• The use of stool-based susceptibility testing eliminates the need for gastric biopsies which effectively eliminates the major impediment to being able to dissect the reasons for treatment failures, thus promoting efficient optimization.

• It is expected that the effect of a convenient and widespread H. pylori susceptibility testing will provide pharmacological with many opportunities associated with the need to markedly change clinical practices.

Declaration of interest

DY Graham is a consultant for RedHill Biopharma and Phathom Pharmaceuticals regarding novel Helicobacter pylori therapies. He has received research support for culture of H. pylori and is the principal investigator of an international study of the use of anti-mycobacterial therapy for Crohn’s disease. The authors have no other relevant affiliations or financial involvement with any organization or entity with a financial interest in or financial conflict with the subject matter or material discussed in the manuscript apart from those disclosed.

Reviewer disclosures

Peer reviewers on this manuscript have no relevant financial or other relationships to disclose.

Author contributions

Both authors were responsible for the concept and writing of the manuscript, tables, and figures.

Additional information

Funding

DY Graham is supported in part by the Office of Research and Development Medical Research Service Department of Veterans Affairs, Public Health Service grant DK56338, which funds the Texas Medical Center Digestive Diseases Center.