Response to: Reply on "Renewed Helicobacter pylori management and therapy in 2015".

Sir,

We thank Abadi for his comments on our editorial,[12] that discussed the prospective, randomized, single-blind, controlled study conducted in Shanghai by Wang et al., who compared the efficacy of a 7-day versus a 14-day clarithromycin-based regimen for Helicobacter pylori eradication.[3] Considering the reported strategies aiming to overcome the increasing H. pylori antibiotic resistance, in particular to clarithromycin,[45] Abadi agrees with us that lengthening the treatment from 7 to 14 days confers no significant advantages on eradication rate. We concur with him on the fact that levofloxacin, the fluoroquinolone more often used in the studies involving H. pylori eradication, is the drug that in the short-term should replace clarithromycin. However, we disagree with the author's contention that flouroquinolone-based therapy followed by specific polymerase chain reaction to detect its mutations is a good alternative in clinical practice. We believe that there is no reason to perform this test, when appropriate, after the treatment. Although it is unclear if molecular tests are less expensive than culture-based susceptibility testing, the latter is time consuming and lacks standardization. As the majority of antibiotic resistance mechanisms in H. pylori are restricted to specific point mutations, molecular-based methods offer an attractive alternative. In contrast to culture-based susceptibility assays, these methods are reproducible and easily standardized, as they are independent of cell viability and growth rate of the bacteria. Hence, when available, this could be an interesting approach to guide the treatment.

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