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

Clin Gastroenterol Hepatol. 2010 Sep;8(9):817-820.e3. doi: 10.1016/j.cgh.2010.05.006. Epub 2010 May 31.


Background & aims: Helicobacter pylori attaches to gastric mucosa and grows as a biofilm. This constitutes protection from antimicrobial agents. We assessed the role of a pretreatment with n-acetylcysteine in destroying biofilm and overcoming H pylori antibiotic resistance.

Methods: In an open-label, randomized controlled trial, 40 subjects with a history of at least 4 H pylori eradication failures were evaluated for biofilm presence, antibiotic susceptibility, and H pylori genotypes. Subjects were assigned randomly to receive (group A) or not (group B) n-acetylcysteine before a culture-guided antibiotic regimen. The primary end point was the H pylori eradication rate as assessed by (13)C-labeled urea breath testing.

Results: H pylori was eradicated in 13 of 20 (both per-protocol and intention-to-treat analyses, 65%; 95% confidence interval, 44%-86%) group A participants and 4 of 20 (both per-protocol and intention-to-treat analyses, 20%; 95% confidence interval, 3%-37%) group B participants (P < .01). Biofilms persisted only in unsuccessfully treated participants. H pylori genotypes did not influence treatment outcome.

Conclusions: N-acetylcysteine pretreatment before a culture-guided antibiotic regimen is effective in overcoming H pylori antibiotic resistance.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Acetylcysteine / therapeutic use*
  • Anti-Bacterial Agents / therapeutic use*
  • Biofilms / drug effects*
  • Biofilms / growth & development
  • Breath Tests
  • Drug Therapy, Combination
  • Expectorants / therapeutic use*
  • Female
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori / drug effects*
  • Helicobacter pylori / growth & development
  • Humans
  • Male
  • Middle Aged
  • Treatment Outcome
  • Urea / analysis


  • Anti-Bacterial Agents
  • Expectorants
  • Urea
  • Acetylcysteine