pylori infection. Concomitant therapy may be more suitable for patients with dual resistance to antibiotics [59]. Probiotics may be also a useful HM781-36B chemical structure adjunct with increased rates of eradication reported in some studies [60]. Lactobacilli would appear to be the most suitable agent. In one review,

an increased pooled eradication rate from 77% to 82% was noted [61]. Culture and susceptibility testing for H. pylori is usually reserved for treatment failures, in which instance it is suggested by the Maastricht consensus [5]. Susceptibility testing is very commonly employed in other latent conditions such as tuberculosis and may well represent a useful strategy in H. pylori treatment. It is limited by the fact that in vivo resistance may not accurately reflect in vitro resistance, notably with respect to metronidazole [62]. Currently, such an approach is only carried out in specialist centers with research interest Ensartinib and expertise in the treatment of H. pylori [63]. However, should this practice become more widespread, it would lead to undoubted benefits such as more accurate prescribing

and consequently lower rates of resistance. It is probably the case that the majority of clinicians viewed H. pylori eradication treatment with a certain degree of complacency over most of the last decade. The recent decline in eradication rates has inspired a revival of interest in the topic, and there are many exciting new options and combinations which have the potential to raise eradication rates to more acceptable levels. In spite of these new developments, the two most critical concepts are those of compliance and antibiotic resistance. Compliance involves effort on behalf of both

doctor and patient and mandates a strict protocol for repeat testing to ensure the eradication of the pathogen and the prescription of defined second Florfenicol and third-line therapies if necessary. Should this be assured, it has been repeatedly illustrated that full or near full eradication of this pathogen in affected patients is eminently achievable [64–66]. If compliance is neglected, by using of unpalatable or overly prolonged or complex regimens, it is to be expected that antibiotic resistance will continue to be a problem that besets eradication therapies. Centers with a research or academic interest have a role to play in compiling data on a frequent and comprehensive basis about the levels of resistance to the most commonly anti-H. pylori antibiotics in their communities. As resistance rates are variable worldwide, this needs to be carried out in all regions. The upcoming fourth Maastricht consensus meeting will be focussing its attention further on H. pylori eradication in respect of the prevention of gastric cancers.