Helicobacter pylori infection

Abstract

New guidelines share many universal similarities across countries but respect and emphasize specific needs and requirements in individual communities. Various combinations of traditional drugs have been successfully introduced to overcome the increasing H. pylori antibiotic resistance. Gastric cancer prevention by a screen and treat strategy showed promising results.

Antimicrobial resistance in Helicobacter pylori: current situation and management strategy in Vietnam

“…The latest IV Maastricht consensus recommends that PPI-clarithromycin-containing triple therapy without prior susceptibility testing should be abandoned in areas where clarithromycin resistance recorded is higher than 20% [6]. Therefore, according to this advice, the use of clarithromycin should be dissuaded in Vietnam as first-line treatment of H. pylori infection without a preliminary assessment of drug susceptibility.…”

“…For these groups, the acceptable resistance levels are set as 20%. The recommendations and therapies available for the eradication of H. pylori are mentioned as first-, second-, and third-line treatments, according to clarithromycin resistance [6] as summarized in Table 1.…”

“…Treatment of H. pylori infection in Vietnam follows the latest international guideline (the Maastricht IV/ Florence Consensus Report) [6]. It is currently recommended to split first-line empiric therapy into two large groups: populations with low (< 20%) and with high resistance (≥ 20%) to clarithromycin.…”

“…Therefore, currently in Vietnam first-line strategies such as bismuth-based quadruple therapy (a combination of a PPI, bismuth subsalicylate 525mg four times daily, and 2 antibiotics, metronidazole 250mg four times daily and tetracycline 500mg four times daily, for 10-14 days) or non bismuth-based quadruple therapy [6] with sequential therapy (the combination of a PPI and amoxicillin 1g twice daily for 5 days, followed by a PPI and clarithromycin plus metronidazole or tinidazole 500 mg twice daily for 5 days) or concomitant therapy (simultaneous administration of 3 antibiotics metronidazole, clarithromycin, amoxicillin and a PPI for 10 days) may be more effective.…”

“…In this view a successful eradication therapy appears essential not only to reduce the risk of developing gastric cancer but also to treat other severe related disorders such as peptic ulcer disease, gastric mucosa-associated lymphoid tissue lymphoma, iron deficiency anemia, hemorrhage idiopathic thrombocytopenia [6].…”