Optimal therapy for Helicobacter pylori infections

Abstract

Although Helicobacter pylori infection is both a common and a serious bacterial infection, antimicrobial therapies have rarely been optimized, are prescribed empirically, and provide inferior results compared with antimicrobial therapies for other common infectious diseases. The effectiveness of many of the frequently recommended H. pylori infection treatment regimens has been increasingly compromised by antimicrobial resistance. Regional data on the susceptibility of strains of H. pylori to available antimicrobials are sorely needed. Noninvasive molecular methods are possible to assess clarithromycin susceptibility in isolates obtained from stool specimens. As a general rule, clinicians should prescribe therapeutic regimens that have a ≥90% or, preferably, ≥95% eradication rate locally. If no available regimen can achieve a ≥90% eradication rate, clinicians should use the most effective regimen(s) available locally. Eradication of infection should always be confirmed after treatment in order to provide feedback regarding local effectiveness and an early warning of increasing resistance. In most regions of the world, four-drug treatment regimens, including a PPI plus three antimicrobials (clarithromycin, metronidazole/tinidazole and amoxicillin), or a PPI plus a bismuth plus tetracycline and metronidazole provide the best results. Standard triple therapy (a PPI, amoxicillin and clarithromycin) should now be avoided owing to increasing resistance to this treatment.

Improved Eradication Rate of Standard Triple Therapy by Adding Bismuth and Probiotic Supplement for Helicobacter pylori Treatment in Thailand

“…Adverse events 7-day plus probiotic 7-day plus placebo P-value 14-day plus probiotic 14-day plus placebo P-value (n=25) (n=25) (n=25) therapy with clarithromycin-containing regimen was reported to be less than 80% in many countries worldwide, including Thailand, due to many factors such as, antibiotic resistance, especially clarithromycin-resistant strain (Vilaichone et al, 2006, Graham, 2009, Mahachai et al, 2011, Rimbara et al, 2011. Bismuth has long been known as an anti-H. pylori drug with minimal side effects.…”

Determinación de mutaciones de un solo nucleótido en el gen 23S rRNA de Helicobacter pylori relacionadas con resistencia a claritromicina en una población del departamento del Cauca, Colombia

“…Es la principal causa de gastritis crónica, úlceras pépticas gastroduodenales y adenocarcinoma gástrico (1). Asimismo, produce linfomas gástricos de tipo MALT (Mucosa-Associated Lymphoid Tissue) (2,3), anemia ferropénica (4), y se relaciona, por lo menos, con 50 % de los casos de púrpura trombocitopénica inmune (5).…”

“…La prueba de referencia de las pruebas de biología molecular para la detección de mutaciones es la secuenciación, una técnica sencilla en la que se amplifica por PCR convencional el gen de interés para después determinar la presencia de mutaciones por secuenciación directa y análisis bioinformático (1,7). Esta es una estrategia que se ha utilizado con éxito en la determinación de mutaciones relacionadas con resistencia a la claritromicina, en especial en áreas geográficas en donde los cultivos de la bacteria no están disponibles.…”

Mutations frequency of RdxA a nitroreductase Helicobacter pylori for activation of metronidazole: a population study in the Department of Cauca

“…La combinación de metronidazol con otros antibióticos se utiliza ampliamente en el tratamiento estándar contra la infección por H. pylori y otras infecciones bacterianas anaerobias (32)(33)(34)(35)(36)(37). Sin embargo, la resistencia de la bacteria al metronidazol es una de las causas del fracaso del tratamiento de dolencias gástricas (7).…”