gc) Biofilm demolition and antibiotic treatment to eradicate resistant Helicobacter pylori: a clinical trial.

BACKGROUND & AIMS: Helicobacter pylori attaches to gastric\r\nmucosa and grows as a biofilm. This constitutes protection\r\nfrom antimicrobial agents. We assessed the role of a pretreatment\r\nwith n-acetylcysteine in destroying biofilm and overcoming H\r\npylori antibiotic resistance. METHODS: In an open-label, randomized\r\ncontrolled trial, 40 subjects with a history of at least 4 H\r\npylori eradication failures were evaluated for biofilm presence, antibiotic\r\nsusceptibility, and H pylori genotypes. Subjects were assigned\r\nrandomly to receive (group A) or not (group B) n-acetylcysteine\r\nbefore a culture-guided antibiotic regimen. The primary\r\nend point was the H pylori eradication rate as assessed by 13Clabeled\r\nurea breath testing. RESULTS: H pylori was eradicated\r\nin 13 of 20 (both per-protocol and intention-to-treat analyses,\r\n65%; 95% confidence interval, 44%–86%) group A participants\r\nand 4 of 20 (both per-protocol and intention-to-treat analyses,\r\n20%; 95% confidence interval, 3%–37%) group B participants\r\n(P .01). Biofilms persisted only in unsuccessfully treated\r\nparticipants. H pylori genotypes did not influence treatment\r\noutcome. CONCLUSIONS: N-acetylcysteine pretreatment\r\nbefore a culture-guided antibiotic regimen is effective in overcoming\r\nH pylori antibiotic resistance.