Abstract
Background and aims: Only a few antimicrobials are effective against H. pylori, and antibiotic resistance is an increasing problem for eradication therapies. In 2017, the World Health Organization categorized clarithromycin resistant H. pylori as a “high-priority” bacterium. Standard antimicrobial susceptibility testing can be used to prescribe appropriate therapies but is currently recommended only after the second therapeutic failure. H. pylori is, in fact, a “fastidious” microorganism; culture methods are time-consuming and technically challenging. The advent of molecular biology techniques has enabled the identification of molecular mechanisms underlying the observed phenotypic resistance to antibiotics in H. pylori. The aim of this literature review is to summarize the results of original articles published in the last ten years, regarding the use of Next Generation Sequencing, in particular of the whole genome, to predict the antibiotic resistance in H. pylori. Methods: a literature research was made on PubMed. The research was focused on II and III generation sequencing of the whole H. pylori genome. Results: Next Generation Sequencing enabled the detection of novel, rare and complex resistance mechanisms. The prediction of resistance to clarithromycin, levofloxacin and amoxicillin is accurate; for other antimicrobials, such as metronidazole, rifabutin and tetracycline, potential genetic determinants of the resistant status need further investigation.
Highlights
IntroductionStandard antimicrobial susceptibility testing (AST) can be used to prescribe appropriate therapies but is currently recommended only after the second therapeutic failure [1] because it requires an invasive test such as endoscopy, and culture methods are challenging and time-consuming [2]
Introduction published maps and institutional affilAntibiotic resistance is an increasing problem for H. pylori eradication therapies.Standard antimicrobial susceptibility testing (AST) can be used to prescribe appropriate therapies but is currently recommended only after the second therapeutic failure [1] because it requires an invasive test such as endoscopy, and culture methods are challenging and time-consuming [2]
Clarithromycin (CLA) is a bacteriostatic antibiotic, it belongs to the group of macrolides that bind reversibly to the peptidyl transferase loop of domain V of the 23SrRNA, interfering with protein elongation and blocking protein synthesis
Summary
Standard antimicrobial susceptibility testing (AST) can be used to prescribe appropriate therapies but is currently recommended only after the second therapeutic failure [1] because it requires an invasive test such as endoscopy, and culture methods are challenging and time-consuming [2]. Aim of this literature review is to summarize the results of original articles published in the last ten years, using the whole genome Generation. A few antimicrobials are effective against H. pylori, and antibiotic resistance is an increasing problem for eradication therapies. The aim of this literature review is to summarize the results of original articles published in the last ten years, regarding the use of Generation Sequencing, in particular of the whole genome, to predict the antibiotic resistance in H. pylori. The prediction of resistance to clarithromycin, levofloxacin and amoxicillin is accurate; for other antimicrobials, such as metronidazole, rifabutin and tetracycline, potential genetic determinants of the resistant status need further investigation
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