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DRUG RESISTANCE IN HELICOBACTER PYLORI.

H. pylori infection determines an important acute and chronic gastric mucosa inflammation. If untreated, the inflammation may remain forever, being infrequently spontaneously eliminated. It is known that chronic gastritis caused by this infection may lead to atrophic gastritis, intestinal metaplasia and dysplasia, thus setting the role of H. pylori in gastric carcinogenesis cascade(4,7). Therefore recent meetings on the subject suggest to eradicate this organism in all infected individuals(2,3,8). The most widely used treatment consists of an association of clarithomycin, amoxyllin and a proton pump inhibitor (PPI) during 7 days(3,8). However, it is noticed that the currently used treatments in order to eradicate H. pylori present decreasing levels of success. The Maastricht IV Consensus Report. draws attention to some factors that may commit the efficacy of the threefold scheme, such as high resistance to antibiotics, specially to clarithomycin; incomplete treatment compliance; high gastric acidity, high bacterial load and different strains of H. pylori(8). This months’ edition of Archives of Gastroenterology journal publishes an excellent review paper on the resistance of H. pylori to antimicrobials, written by Vianna et al.(12). The authors carried a careful and comprehensive literature review on available methods to diagnose bacterial resistance, further highlighting the current susceptibility to each of the antibiotics used to treat this infection and the main factors associated with resistance in these cases. In fact, recent molecular studies showed high levels of H. pylori resistance to some antibiotics that are routinely used in eliminating schemes, especially clarithomycin and fluoroquinolones(7). Many of these studies have shown that resistance to clarithomycin is really high in some regions of the world, directly affecting the eradication of H. pylori. An European multicenter study comprising 18 countries showed high levels of resistance to both clarithomycin (17.5%) and fluoroquinolones (14.1%), varying widely according to the regions(9,13). For this reason, the latest Maastricht Consensus do not recommend the use of this antibiotic as first line of treatment in regions where resistance to clarithomycin rates are higher than 15%20%(8). This is the case, for example, of some regions in Italy and in Poland, where the first choice schemes no longer include the macrolide(1,10,13). DRUG RESISTANCE IN HELICOBACTER PYLORI