Biofilm Demolition and Antibiotic Treatment to Eradicate Resistant Helicobacter pylori: A Clinical Trial.
Cammarota, Giovanni *,*; Branca, Giovanna ++; Ardito, Fausta ++; Sanguinetti, Maurizio ++; Ianiro, Gianluca *; Cianci, Rossella *; Torelli, Riccardo *; Masala, Giovanna [S]; Gasbarrini, Antonio *; Fadda, Giovanni ++; Landolfi, Raffaele *; Gasbarrini, Giovanni *
[Miscellaneous Article]
Clinical Gastroenterology & Hepatology.
8(9):817-820e3, September 2010.
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BACKGROUND & AIMS: Helicobacter pylori attaches to gastric mucosa and grows as a biofilm. This constitutes protection from antimicrobial agents. We assessed the role of a pretreatment with n-acetylcysteine in destroying biofilm and overcoming H pylori antibiotic resistance.
METHODS: In an open-label, randomized controlled trial, 40 subjects with a history of at least 4 H pylori eradication failures were evaluated for biofilm presence, antibiotic susceptibility, and H pylori genotypes. Subjects were assigned randomly to receive (group A) or not (group B) n-acetylcysteine before a culture-guided antibiotic regimen. The primary end point was the H pylori eradication rate as assessed by 13C-labeled urea breath testing.
RESULTS: H pylori was eradicated in 13 of 20 (both per-protocol and intention-to-treat analyses, 65%; 95% confidence interval, 44%-86%) group A participants and 4 of 20 (both per-protocol and intention-to-treat analyses, 20%; 95% confidence interval, 3%-37%) group B participants (P < .01). Biofilms persisted only in unsuccessfully treated participants. H pylori genotypes did not influence treatment outcome.
CONCLUSIONS: N-acetylcysteine pretreatment before a culture-guided antibiotic regimen is effective in overcoming H pylori antibiotic resistance.
(C) 2010Elsevier, Inc.
