Drug Resistance Testing in H pylori: Choice Is A Promise

Drug-resistant H. pylori is a ubiquitous health issue that has significantly reduced the effectiveness of treatment plans. It is evident that the emerging rates of antimicrobial resistance pose a significant challenge in the successful management of H. pylori infection and that resistance surveillance is warranted.

Therefore, periodic regional drug susceptibility surveillance programs and the implementation of policies for the prudent use of antibiotics should be of the utmost importance. Antibiotic susceptibility testing (AST) is essential for tailoring H. pylori therapy and developing treatment recommendations for certain populations based on main resistance patterns. The detection of antibiotic resistance can be assessed either by phenotypic methods or by genotypic methods.

Phenotypic method should be considered in all regions before second-line treatment is prescribed if endoscopy is performed. Furthermore, antimicrobial susceptibility testing is recommended in all regions when a second-line treatment has failed. 

Resistance testing has been dramatically transformed by genotypic approaches, and the combination of WGS with conventional phenotypic resistance data can yield significant results in identifying novel resistance mechanisms. Research is still being done to determine the relative impact of each mutation to MIC and the relationship between gene involvement patterns and outcomes.

High rates of resistance mandate the development of new strategies, including increased regional antibiotic resistance surveillance, individual antibiotic susceptibility testing (AST) and the global implementation of antimicrobial stewardship measures. While each approach for detection of resistance has pros and cons of its own, choosing the appropriate diagnosis is a commitment to pursue a definitive solution.