Reasons of failure of eradication therapy, not related to antibiotic resistance of Helicobacter pylori, and the ways to overcome them
Nazarov V.E.
North-western State Medical University named after I. I. Mechnikov, St. Petersburg
The difficulties associated with the eradication of Helicobacter pylori are caused by several reasons. H. pylori has the ability to live in the parietal mucus, to produce biofilms, inactive cocci and U-forms, to acquire resistance of the genetic information exchange with the help of plasmids (transposons) or extracellular DNA, and also remove toxic substances (including antibiotics) from the microbial cell with the help of special efflux-pomp.
In addition, it was found that H. pylori can survive inside phagocytes by blocking bactericidal molecules, which leads to
a decrease in the neutrophil cytotoxicity and incomplete phagocytosis, so that these cells can serve as a source of disease recurrence after the end of antibacterial therapy. Intracellular localization of H. pylori and invasion to the epithelial cells with vacuoles formation is noted.
Discussion of the issues of inadequate treatment is usually limited to the ways of improving the compliance to treatment,
or early termination of treatment due to the development of side effects of therapy. However, this article additionally discusses important aspects: issues of quality of antisecretory and antibacterial drugs, used in eradication therapy, and test systems, used for the primary diagnosis of H. pylori and evaluation of the effectiveness of therapy.
Key words: H. pylori, gastritis, peptic ulcer, eradication, urease test.
For citation: Nazarov V.E. Reasons of failure of eradication therapy, not related to antibiotic resistance of Helicobacter pylori, and the ways to overcome them // RMJ. Medical Review. 2018. № 3. P. 4–12.
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