Reasons for two consecutive Helicobacter pylori treatment failures

The present case focuses on a symptomatic patient with two consecutive Helicobacter pylori treatment failures. H. pylori strain isolated from the patient was susceptible to amoxicillin, metronidazole, tetracycline and rifampin, but was resistant to clarithromycin and ciprofloxacin/levofloxacin. The first treatment failure could be the consequence of a suboptimal treatment regimen (esomeprazole, amoxicillin and tetracycline) despite in vitro susceptibility of the isolate to both antibiotics. The second eradication attempt (esomeprazole, amoxicillin, levofloxacin and colloidal bismuth subcitrate) was unsuccessful due to in vitro resistance of the isolate to quinolones. In conclusion, not all antibiotics can be successfully co-administered simultaneously for H. pylori eradication despite the in vitro susceptibility. The patients should inform clinicians about their previous clinical and paraclinical evaluations, including the bacterial susceptibility testing results to receive the most appropriate treatment regimen.