Efficacy of Acetilcysteine in 'Rescue' Therapy for Helicobacter Pylori Infection. Pilot Study
Status:
Unknown status
Trial end date:
2009-09-01
Target enrollment:
Participant gender:
Summary
H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The
discovery that most upper gastrointestinal diseases are related to H pylori infection and
therefore can be treated with antibiotics is an important medical advance. Currently, a
first-line triple therapy based on proton pump inhibitor (PPI) or ranitidine bismuth citrate
(RBC) plus two antibiotics (clarithromycin and amoxicillin or nitroimidazole) is recommended
by all consensus conferences and guidelines. Even with the correct use of this drug
combination, infection can not be eradicated in up to 23% of patients. Therefore, several
second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth,
tetracycline and metronidazole is the more frequently accepted. However, with second-line
therapy, bacterial eradication may fail in up to 40% of cases. When H pylori eradication is
strictly indicated the choice of further treatment is controversial. When available,
endoscopy with culture and consequent antibiotic susceptibility testing remains the most
appropriate option for patients with two eradication failures to avoid a widespread use of
expensive antibiotics. The use of these drugs may also induce severe side-effects and
development of H pylori resistant strains.
Resistant strains of Helicobacter pylori can display a dense biofilm with mucus and
microorganisms in a coccoid shape on the mucosal surface of stomach that may have a role in
determining the resistance to the antibiotic therapies. Possibly, N-acetil-cysteine (NAC) may
dissolve biofilm architecture and help to eradicate resistant strains of H pylori.