An antimicrobial susceptibility testing-based approach for Helicobacter pylori eradication: will tailored therapy overcome the increasing failure of standard empirical therapy?

Helicobacter pylori infection is a public health issue. It remains one of the most common infections in adults in Ireland (22%) and is associated with significant morbidity and mortality as the primary cause of stomach ulcers and stomach cancers. Infection is more common in lower socioeconomic groups and increases with age. Despite significant work to date resulting in a better understanding of the organism and its complex interaction with man, eradication rates with standard therapies are falling. Primary resistance to commonly employed antibiotics is increasing at an alarming rate, and represents the single largest barrier to the successful management of patients with Helicobacter pylori associated disease. The frequent use of antibiotics such as clarithromycin and metronidazole for common community acquired infections, as well as patient compliance, are major factors which contribute to the decline in treatment success. The wider research community has recognised the need to address antibiotic resistance as a priority and with some urgency. Helicobacter pylori testing for sensitivity to antibiotics is not undertaken routinely in most hospitals and the availability of local primary resistance data is lacking. With a significant track record in Helicobacter pylori research, we aim to assess the prevalence of local H. pylori antibiotic resistance. To achieve our aims we will analyse stomach samples of a representative cohort of patients who have not undergone eradication therapy previously to test for primary antibiotic resistance. We will assess the impact of tailoring therapy based on antibiotic resistance data with a view to improving H. pylori eradication rates. The expertise we develop will assist both community- and hospital-based practitioners through appropriate relevant local feedback on treatments with a view to achieving improved eradication rates and thereby better disease prevention and control.

Award Date: 19 June 2014
Award Value: €181,570
Principal Investigator: Professor Deirdre McNamara
Host Institution: Trinity College Dublin
Scheme: Health Research Awards