Culture-based antibiotic susceptibility testing for Helicobacter pylori infection: a systematic review

Primary antibiotic resistance in ( ) strains is increasing worldwide, affecting therapy success. The use of therapies tailored on susceptibility pre-testing at culture has been proposed, but data are still conflicting. We performed a systematic review to evaluate the role of a culture-based therapeutic approach for treatment, taking into account the sensitivity of culture and the success rates achieved with tailored therapies in different therapeutic steps. We analyzed data from 51 studies. Overall, strains were isolated in 80.7% of 7889 patients, the success rates being 78.1%, 77.5%, 86.3% and 86.6%, before first-, second-, third-line or more therapies, respectively. In comparative studies, the infection was cured in 89.9% of 2052 patients treated with tailored therapies, and in 77.6% of 2516 patients receiving empiric therapy (P90%) only when it was applied before first- and second-line therapies, but not before third-line or more attempts (