Appropriate first-line regimens to combat Helicobacter pylori antibiotic resistance: an Asian perspective

Molecules. 2015 Apr 8;20(4):6068-92. doi: 10.3390/molecules20046068.


Asia has the largest population of any continent and the highest incidence of gastric cancer in the world, making it very important in the context of Helicobacter pylori infection. According to current guidelines, standard triple therapy containing a proton pump inhibitor (PPI) and two antibiotics; amoxicillin (AMX) and clarithromycin (CAM) or metronidazole (MNZ), is still the preferred first-line regimen for treatment of H. pylori infection. However, the efficacy of legacy triple regimens has been seriously challenged, and they are gradually becoming ineffective. Moreover, some regions in Asia show patterns of emerging antimicrobial resistance. More effective regimens including the bismuth and non-bismuth quadruple, sequential, and dual-concomitant (hybrid) regimens are now replacing standard triple therapies as empirical first-line treatments on the basis of the understanding of the local prevalence of H. pylori antimicrobial resistance. Selection of PPI metabolized by the non-enzymatic pathway or minimal first pass metabolism and/or increasing dose of PPI are important to increase H. pylori eradication rates. Therefore, local antibiotic resistance surveillance updates, selection of appropriate first-line regimens with non-enzymatic PPI and/or increased doses of PPI, and detailed evaluation of patients' prior antibiotic usage are all essential information to combat H. pylori antibiotic resistance in Asia.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, Non-U.S. Gov't
  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use*
  • Asia
  • Cytochrome P-450 CYP2C19 / genetics
  • Drug Resistance, Bacterial* / genetics
  • Helicobacter Infections / complications
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / genetics
  • Helicobacter Infections / microbiology*
  • Helicobacter pylori / drug effects*
  • Humans
  • Polymorphism, Single Nucleotide
  • Proton Pump Inhibitors / pharmacology
  • Proton Pump Inhibitors / therapeutic use*
  • Standard of Care
  • Stomach Neoplasms / epidemiology
  • Stomach Neoplasms / etiology
  • Stomach Neoplasms / prevention & control


  • Anti-Bacterial Agents
  • Proton Pump Inhibitors
  • Cytochrome P-450 CYP2C19