<i>Helicobacter pylori</i> Infection: Treatment Options

Abstract

After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy – 7–10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin – followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will re quire the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.

Nitrofuran‐based regimens for the eradication of Helicobacter pylori infection

“…One of the options could be an NF-or F-based quadruple combination as our results showed; the third-line eradication rates are, however, usually lower than the results of primary treatments. [1][2][3]96 Eradication of H. pylori is influenced by different factors. 4 The recommended duration of treatment is 7 days in Europe and Asia, 10 days in South America and 10-14 days in the USA.…”

“…Administering the most effective recommended regimens, proton pump inhibitors (PPI) + two antimicrobials, approximately 20% of the compliant patients will fail to overcome the infection. [1][2][3] Factors influencing the success or failure of a regimen are the patient's compliance and antimicrobial resistance; therefore, the appropriate selection of the patients and choice of antibiotics is of pivotal importance to the treatment outcome. 4,5 According to the European, US, Asian-Pacific and Latin-American Consensus, the standard therapy comprises any of the available PPI + clarithromycin (C) and either amoxicillin (A) or metronidazole (M), all administered b.i.d.…”

Furazolidone, Co-amoxiclav, Colloidal Bismuth Subcitrate, and Esomeprazole for Patients Who Failed to Eradicate Helicobacter pylori with Triple Therapy

“…Factors influencing success or failure of an anti-H. pylori regimen include patient's compliance, antimicrobial resistance, and duration of therapy [2]. The most effective recommended regimen, i.e., a PPI with two antimicrobials such as amoxicillin, clarithromycin, or metronidazole, fails to eradicate infection in more than 20% of the compliant patients [2,13,14]. Therefore, appropriate selection of the patients and choice of antibiotics are of major importance for the treatment outcome [15,16].…”

Interpretation of the 13C-urea breath test in the choice of second- and third-line eradication of Helicobacter pylori infection

“…Other enzymes such as bacterial and mucosal carbonic anhydrase may also be involved in this process. 34 Thus, the actual level of exhaled 13C-urea might be dependent on both bacterial urease, carbonic anhydrase, the H. pylori strain, and On the basis of our experience, we suggest that in cases of high pretreatment UBT values (the higher the UBT values, the lower the rate of eradication), the standard therapeutic regimens might be changed: recent therapeutic options include fi rst-line quadruple treatments, novel antibiotics (rifabutin, levofl oxacin, furazolidone), prolongation of treatment duration, increased doses, 35,36 and sequential therapy. 37 The exact UBT cutoff value for accurate prediction of eradication failure must be determined by prospective studies assessing the sensitivity, specifi city, and positive and negative predictive values of the test, and receiveroperating curve characteristics.…”