Eradication ofHelicobacter pyloriinfection: Which regimen first?

Abstract

Helicobacter pylori (H. pylori) is a well-known human pathogen that plays an essential role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although H. pylori is susceptible to several antimicrobials, this infection has proven challenging to cure because of the increasing prevalence of bacterial strains that are resistant to the most commonly used antimicrobials, particularly clarithromycin. An effective (i.e., > 90%) first-line therapy is mandatory for avoiding supplementary treatments and testing, and more importantly for preventing the development of secondary resistance. This study reviews the recent literature on first-line therapies for H. pylori. The eradication rates following standard triple therapy (a proton pump inhibitor plus amoxicillin and clarithromycin) for H. pylori infection are declining worldwide. Several first-line strategies have been proposed to increase the eradication rate, including extending the treatment duration to 14 d, the use of a four-drug regimen (bismuth-containing quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as fluoroquinolones. However, the efficacy of these regimens is controversial. A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region.

Eradication Rates in Italian Subjects Heterogeneously Managed for Helicobacter pylori Infection. Time to Abandon Empiric Treatments in Southern Europe

“…Our data also indicate that recommendations of European and Italian guidelines allowed optimal eradication rates in our areas, and therefore the final decision of treatment depends on the best available therapeutic option and on the patient's choice [57].…”

Guidelines for the management of Helicobacter pylori infection in Italy: The III Working Group Consensus Report 2015

“…Extensive epidemiological research, especially from Asia, has shown that the interplay between HP infection, host genetic conditions and environmental factors result in a wide variability of gastric cancer incidence among different regions (86,67). In the Hehuang valley in China, the prevalence of HP-infected gastric cancers is astonishingly low and environmental factors could be associated with this malignancy (88).…”

“…When choosing an empirical first-line regimen among those recommended, Italian physicians should take into account what works best in their clinical practice and in their region, as well as the patient"s preference (67).…”

Audit ofHelicobacter pyloriTesting in Microbiology Laboratories in England: To Inform Compliance with NICE Guidance and the Feasibility of Routine Antimicrobial Resistance Surveillance

“…H. pylori treatment failure is often due to antibiotic resistance [3, 4, 15–17]. Despite this, a surveillance system to monitor trends in resistance at a local and national level does not currently exist in England.…”