Revisiting Therapeutic Strategies for H. pylori Treatment in the Context of Antibiotic Resistance: Focus on Alternative and Complementary Therapies

The prevalence of Helicobacter pylori infection remains significant worldwide and it depends on many factors: gender, age, socio-economic status, geographic area, diet, and lifestyle. All successful infectious diseases treatments use antibiotic-susceptibility testing, but this strategy is not currently practical for H. pylori and the usual cure rates of H. pylori are lower than other bacterial infections. Actually, there is no treatment that ensures complete eradication of this pathogen. In the context of an alarming increase in resistance to antibiotics (especially to clarithromycin and metronidazole), alternative and complementary options and strategies are taken into consideration. As the success of antibacterial therapy depends not only on the susceptibility to given drugs, but also on the specific doses, formulations, use of adjuvants, treatment duration, and reinfection rates, this review discusses the current therapies for H. pylori treatment along with their advantages and limitations. As an alternative option, this work offers an extensively referenced approach on natural medicines against H. pylori, including the significance of nanotechnology in developing new strategies for treatment of H. pylori infection.

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Helicobacter pylori: Novel Therapies

Canadian Journal of Gastroenterology ◽

10.1155/1999/485237 ◽

1999 ◽

Vol 13 (7) ◽

pp. 581-583 ◽

Cited By ~ 16

Author(s):

Eric Drouin

Keyword(s):

Helicobacter Pylori ◽

Bacterial Resistance ◽

Novel Therapies ◽

In Vitro Activity ◽

Current Therapies ◽

H Pylori ◽

Cure Rates ◽

Suitable Group ◽

The Ideal

The ideal therapy forHelicobacter pyloriwould cure the infection without resulting in the development of antibiotic resistance. Current therapies have variable cure rates; the reasons for treatment failure include bacterial resistance and poor compliance. Some antibiotics, such as furazolidone, may be affordable agents to treat this infection worldwide. New proton pump inhibitors, such as rabeprazole, can potentiate antibiotics. Nutriceuticals and probiotics demonstrate interesting in vitro activity againstH pylori. Children rarely have symptoms to this infection and, therefore, are a suitable group in which to assess different nonaggressive therapies.

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Synthesis and In Vitro Enzymatic Studies of New 3-Aryldiazenyl Indoles as Promising Helicobacter pylori IMPDH Inhibitors

Current Topics in Medicinal Chemistry ◽

10.2174/1568026619666190227212334 ◽

2019 ◽

Vol 19 (5) ◽

pp. 376-382 ◽

Cited By ~ 4

Author(s):

Sachin Jangra ◽

Gayathri Purushothaman ◽

Kapil Juvale ◽

Srimadhavi Ravi ◽

Aishwarya Menon ◽

...

Keyword(s):

Helicobacter Pylori ◽

Bacterial Infections ◽

Immunosuppressive Drugs ◽

Multi Drug Resistance ◽

Metabolic Enzyme ◽

World Population ◽

Inhibitor Molecule ◽

Nucleotide Synthesis ◽

H Pylori

Background & Objective:Helicobacter pylori infection is one of the primary causes of peptic ulcer followed by gastric cancer in the world population. Due to increased occurrences of multi-drug resistance to the currently available antibiotics, there is an urgent need for a new class of drugs against H. pylori. Inosine 5′-monophosphate dehydrogenase (IMPDH), a metabolic enzyme plays a significant role in cell proliferation and cell growth. It catalyses guanine nucleotide synthesis. IMPDH enzyme has been exploited as a target for antiviral, anticancer and immunosuppressive drugs. Recently, bacterial IMPDH has been studied as a potential target for treating bacterial infections. Differences in the structural and kinetic parameters of the eukaryotic and prokaryotic IMPDH make it possible to target bacterial enzyme selectively.Methods:In the current work, we have synthesised and studied the effect of substituted 3-aryldiazenyl indoles on Helicobacter pylori IMPDH (HpIMPDH) activity. The synthesised molecules were examined for their inhibitory potential against recombinant HpIMPDH.Results:In this study, compounds 1 and 2 were found to be the most potent inhibitors amongst the database with IC50 of 0.8 ± 0.02µM and 1 ± 0.03 µM, respectively.Conclusion:When compared to the most potent known HpIMPDH inhibitor molecule C91, 1 was only four-fold less potent and can be a good lead for further development of selective and potent inhibitors of HpIMPDH.

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EFFECT OF THE HEXANIC EXTRACT OF TAGETES LUCIDA ON THE INHIBITION OF THE GROWTH OF ENTEROBACTERIA SHIGELLA FLEXNERI AND SALMONELLA TYPHI

Anales de la Real Academia Nacional de Farmacia ◽

10.53519/analesranf.2020.86.02.02 ◽

2020 ◽

pp. 113-116

Author(s):

Jorge Ángel Almeida-Villegas ◽

Rodolfo García-Contreras ◽

Miriam Deyanira Rodríguez ◽

Yahira Katherine Porras-Hernández ◽

Meliksetyan Lilit Surenovna ◽

...

Keyword(s):

Bacterial Infections ◽

Shigella Flexneri ◽

Salmonella Typhi ◽

Hexane Extract ◽

Gram Negative Bacteria ◽

Active Metabolites ◽

Inhibition Of Growth ◽

Total Inhibition ◽

Medicinal Plant Extracts ◽

New Strategies

Antibiotic resistance increases the search for new strategies to combat the diseases they cause, and the use of medicinal plants represents a highly effective and valuable strategy, such as the use of Tagetes lucida with different gram positive and gram negative bacteria. Objective: To evaluate the biological activity of the hexane extract of the Tagetes lucida plant at different concentrations on the inhibition of growth in plaque and tube of two enterobacteriaceae, Shigella flexneri and Salmonella typhi Methods: In the following work, a hexane extract from Tagetes lucida was evaluated on the growth inhibition of two enterobacteriaceae, Shigella flexneri and Salmonella typhi using different concentrations of vehicle to evaluate if it affected bacterial growth and also different concentrations of extract to evaluate activity. Results: Once the studies were carried out in triplicate, it was possible to specify that from 75µl/µg of extract, almost total inhibition of the growth of both bacteria was achieved, both in the plate method and in the tube method. And from 100 µl/µg total inhibition is achieved. Conclusions: The favorable results obtained with 75 µl/ µg, confirm that medicinal plant extracts are an important strategy to combat multi-drug resistant bacterial infections. On the other hand, it allows a study to be carried out to evaluate the most active metabolites of the extract, as well as the mechanism of action on the inhibition of the growth of the bacteria under study.

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Effcacy of quadruple therapy for the treatment of H. pylori infection at Gia Dinh people’s hospital

Tạp chí Y học Dự phòng ◽

10.51403/0868-2836/2020/244 ◽

2021 ◽

Vol 30 (4) ◽

pp. 12-19

Author(s):

Nguyen Thi Minh Thuan ◽

Luong Thi Ha Vi

Keyword(s):

Side Effects ◽

Bacterial Infections ◽

Cross Sectional Study ◽

Consensus Conference ◽

Total Rate ◽

Cross Sectional ◽

Quadruple Therapy ◽

First Choice ◽

H Pylori ◽

Gastroenterology Unit

Helicobacter pylori (H. pylori) infection is one of the most common chronic bacterial infections in the world. For the purpose of eradicating H. pylori, quadruple therapies are widely prescribed in patients infected with H. pylori. According to the Maastricht V Consensus Conference, in regions where the rate of resistance of H. pylori to CLR and MTZ is high such as Viet Nam, bismuth quadruple therapy is the first choice. However, bismuth also causes many side efects. The aim of this study was to assess the effectiveness of quadruple therapies on H. pylori infection at Gia Dinh people’s hospital. Seventy-one patients aged 18 years old and older diagnosed with H. pylori infection at the Gastroenterology Unit of Gia Dinh People’s hospital were enrolled in this descriptive cross–sectional study. The efficacy and frequency of side effects of bismuth and non-bismuth quadruple therapies for H. pylori eradication were evaluated and the total rate of H. pylori eradication with both therapies was reported to be 70.4%. The success rate of bismuth quadruple therapy was 80.0%, significantly higher than that of non bismuth quadruple therapy (47.6%). Additionally, the frequency of side effects encountered by bismuth quadruple therapy was insignificantly higher than non-bismuth quadruple therapy (p > 0.05). In conclusion, the effectiveness of treatment with bismuth quadruple therapy was higher than that with non-bismuth quadruple therapy.

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Jamming bacterial communications: new strategies to combat bacterial infections and the development of biofilms

Bacterial Cell-to-Cell Communication ◽

10.1017/cbo9780511541506.005 ◽

2009 ◽

pp. 65-100 ◽

Cited By ~ 1

Author(s):

Michael Givskov ◽

Morten Hentzer

Keyword(s):

Bacterial Infections ◽

New Strategies

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Eradication of Helicobacter pylori: the power of nanosized formulations

Nanomedicine ◽

10.2217/nnm-2019-0329 ◽

2020 ◽

Vol 15 (5) ◽

pp. 527-542

Author(s):

Qianyu Zhang ◽

Wen Wu ◽

Jinqiang Zhang ◽

Xuefeng Xia

Keyword(s):

Helicobacter Pylori ◽

Antibiotic Resistance ◽

Peptic Ulcer ◽

Gastric Carcinoma ◽

Antibacterial Agents ◽

Antimicrobial Agents ◽

Mucosal Barrier ◽

Harsh Environment ◽

H Pylori ◽

Cure Rates

Helicobacter pylori is a pathogen that is considered to cause several gastric disorders such as chronic gastritis, peptic ulcer and even gastric carcinoma. The current therapeutic regimens mainly constitute of a combination of several antimicrobial agents and proton pump inhibitors. However, the prevalence of antibiotic resistance has been significantly lowering the cure rates over the years. Nanocarriers possess unique strengths in this regard owing to the fact that they can protect the drugs (such as antibiotics) from the harsh environment in the stomach, penetrate the mucosal barrier and deliver drugs to the desired site. In this review we summarized recent studies of different antibacterial agents orally delivered by nanosized carriers for the eradication of H. pylori.

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Optimization Strategies Aimed to Increase the Efficacy of Helicobacter pylori Eradication Therapies with Quinolones

Molecules ◽

10.3390/molecules25215084 ◽

2020 ◽

Vol 25 (21) ◽

pp. 5084

Author(s):

Javier P. Gisbert

Keyword(s):

Gastroduodenal Ulcer ◽

Eradication Therapy ◽

Ulcer Disease ◽

Simple Alternative ◽

Third Line ◽

H Pylori ◽

Triple Regimen ◽

Meta Analyses ◽

Cure Rates

H. pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. Fluoroquinolones such as levofloxacin, or more recently moxifloxacin or sitafloxacin, are efficacious alternatives to standard antibiotics for H. pylori eradication. The aim of the present review is to summarize the role of quinolone-based eradication therapies, mainly focusing on the optimization strategies aimed to increase their efficacy. Several meta-analyses have shown that, after failure of a first-line eradication treatment, a levofloxacin-containing rescue regimen is at least equally effective, and better tolerated, than the generally recommended bismuth quadruple regimen. Compliance with the levofloxacin regimens is excellent, and the safety profile is favourable. Higher cure rates have been reported with longer treatments (>10–14 days), and 500 mg levofloxacin daily is the recommended dose. Adding bismuth to the standard triple regimen (PPI-amoxicillin-levofloxacin) has been associated with encouraging results. Unfortunately, resistance to quinolones is easily acquired and is increasing in most countries, being associated with a decrease in the eradication rate of H. pylori. In summary, a quinolone (mainly levofloxacin)-containing regimen is an encouraging second-line (or even third-line) strategy, and a safe and simple alternative to bismuth quadruple therapy in patients whose previous H. pylori eradication therapy has failed.

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Socio-economic status in childhood but not adulthood predicts H. pylori infection: The bristol helicobacter project

Gastroenterology ◽

10.1016/s0016-5085(00)83998-0 ◽

2000 ◽

Vol 118 (4) ◽

pp. A470

Author(s):

Athene J. Lane ◽

Matthias Egger ◽

Liam J. Murray ◽

Jenny L. Donovan ◽

Ian M. Harvey ◽

...

Keyword(s):

Economic Status ◽

Socio Economic Status ◽

H Pylori

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Helicobacter pyloriAntibiotic Resistance: Trends Over Time

Canadian Journal of Gastroenterology ◽

10.1155/2000/218256 ◽

2000 ◽

Vol 14 (10) ◽

pp. 895-899 ◽

Cited By ~ 18

Author(s):

Raymond G Lahaie ◽

Christiane Gaudreau

Keyword(s):

Bacterial Infections ◽

Bacterial Resistance ◽

Reliable Data ◽

Asian Countries ◽

Resistance To Antibiotics ◽

Treatment Regimens ◽

The World ◽

Trends Over Time ◽

H Pylori ◽

Resistance Rates

Resistance to antibiotics can be a major problem in the treatment of bacterial infections. As the use of antibiotics increases, bacterial resistance to these agents is rising and in many cases is responsible for the failure of treatment regimens. Although the treatment ofHelicobacter pyloriinfection requires the use of more than one antibiotic to obtain adequate eradication rates, the efficacy of the currently used antibiotic combinations has been shown to be decreased by resistance to one of the antibiotics. The use of antibiotics in regimens for the treatment ofH pyloriis increasing in many countries, including Canada. This increase is both in the use of these antibiotics alone for the treatment of nongastrointestinal infections and in their use in association with proton pump inhibitors for the treatment ofH pyloriinfection. In several European and Asian countries, where resistance to antibiotics is being monitored, it has been demonstrated thatH pyloriresistance to metronidazole and to clarithromycin increased throughout the 1990s. Thus far, the data available in Canada do not show increased resistance to either of these antibiotics. As for other antibiotics used in the treatment ofH pyloriinfection, such as tetracycline and amoxicillin, the rate of resistance to these agents is still very low and does not constitute a significant problem. Because the efficacy of the regimens used in the treatment ofH pyloriinfection is compromised by resistance to the antibiotics used, it is important thatH pyloriresistance rates in Canada and throughout the world continue to be monitored. Only with such reliable data can the most optimal regimens be recommended.

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