A new look at anti-Helicobacter pylori therapy

World J Gastroenterol. 2011 Sep 21;17(35):3971-5. doi: 10.3748/wjg.v17.i35.3971.

Abstract

With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e., 80% or less) in most countries. Therefore, several treatment regimens have emerged to cure Helicobacter pylori (H. pylori) infection. Novel first-line anti-H. pylori therapies in 2011 include sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy. After the failure of standard triple therapy, a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI), bismuth, tetracycline and metronidazole can be employed as rescue treatment. Recently, triple therapy combining a PPI, levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy. This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects. The best second-line therapy for patients who fail to eradicate H. pylori with first-line therapies containing clarithromycin, amoxicillin and metronidazole is unclear. However, a levofloxacin-based triple therapy is an accepted rescue treatment. Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test. Nonetheless, an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H. pylori infection if antimicrobial sensitivity data are unavailable.

Keywords: Bismuth-containing quadruple therapy; Concomitant quadruple therapy; Hybrid (dual-concomitant) therapy; Rescue anti- Helicobacter pylori treatment; Sequential therapy.

Publication types

  • Review

MeSH terms

  • Amoxicillin / pharmacology
  • Amoxicillin / therapeutic use
  • Anti-Infective Agents / pharmacology*
  • Anti-Infective Agents / therapeutic use*
  • Bismuth / pharmacology
  • Bismuth / therapeutic use
  • Clarithromycin / pharmacology
  • Clarithromycin / therapeutic use
  • Drug Resistance, Bacterial
  • Drug Therapy, Combination
  • Helicobacter Infections / drug therapy*
  • Helicobacter pylori / drug effects*
  • Humans
  • Levofloxacin
  • Metronidazole / pharmacology
  • Metronidazole / therapeutic use
  • Ofloxacin / pharmacology
  • Ofloxacin / therapeutic use
  • Tetracycline / pharmacology
  • Tetracycline / therapeutic use

Substances

  • Anti-Infective Agents
  • Metronidazole
  • Levofloxacin
  • Amoxicillin
  • Ofloxacin
  • Tetracycline
  • Clarithromycin
  • Bismuth