Lessons From Using Culture-Guided Treatment After Referral for Multiple Treatment Failures for Helicobacter pylori Infection

Helicobacter pylori (H. pylori) is an important human pathogen thought to play a causative role in many gastrointestinal diseases including gastritis, peptic ulcer, and gastric cancer. The efficacy of the commonly recommended empirical combination therapies used in eradicating H. pylori has declined to the point that in most regions traditional empiric therapies are no longer effective 1. Although there have been a number of recently published guidelines and recommendations for treating H. pylori 2–5, failures are still common 6. Resistance to clarithromycin, metronidazole and fluoroquinolones are increasingly reported and are strongly associated with treatment failures. Culture-guided treatment is standard for infectious diseases where antimicrobial resistance is common as it allows therapy to be tailored to antimicrobial susceptibilities 7. Susceptibility-based therapy is especially important to guide tailored treatment after failure of standard empirical therapies. However, the effectiveness of culture-guided and sensitivity based treatment of H. pylori in a referral setting in the United States is unknown.