Recent Advances in the Treatment of Helicobacter pylori Infection

Abstract

The approach to the treatment of Helicobacter pylori infection has changed during the last years. In fact, during the last decade, the success rate of usual eradication regimens, based on a proton pump inhibitor plus clarithromycin associated with amoxicillin or metronidazole, declined from over 90% to about 80%, a critical threshold under which the eradication rate is considered unsatisfactory, according to current guidelines. This finding is mainly due to the raising prevalence of clarithromycin resistance, which is in turn linked to the widespread use of this antibiotic for respiratory tract infections. Therefore, obtaining a personal history negative for a previous use of macrolides is now mandatory, before administering clarithromycin-based antibiotic therapy. Should history data be uncertain, local resistance rates (if available) may be considered, with levels higher than 20% precluding the use of clarithromycin. In this case, alternative antibiotic combinations, previously used in the rare instances of failure of clarithromycin-based therapy, should be used. We examined also the possible additional beneficial effect of some novel non antibiotic agents such as lactoferrin, probiotics and natural substances. Other advances in the treatment of the infection are represented by the discovery that some extragastric disorders such as unexplained iron deficiency anemia and idiopathic thrombocytopenic purpura, may be causally linked to Helicobacter pylori, and that eradication therapy may lead to their regression in many cases. Finally, some "gray areas" (nonulcer dyspepsia, concomitant use of nonsteroidal anti-inflammatory drugs) which are the subject of debate as far the indication to treatment is concerned, have been discussed.

Synergistic antibacterial efficacies of the combination of bovine lactoferrin or its hydrolysate with probiotic secretion in curbing the growth of meticillin-resistant Staphylococcus aureus

“…Synergy has also been observed between hLf and lysozyme, as each protein alone is bacteriostatic, but in combination they can be bactericidal against Vibrio cholerae , Salmonella typhimurium and E. coli strains (Ellison & Giehl, 1991; Singh et al , 2000). Experiments performed in vivo using a combination of bLf with probiotic and antibiotics, including esomeprazole, clarithromycin and amoxicillin, have been found to improve the bacterial eradication rate and reduced the side-effects of antibiotic treatment (Bergamaschi et al , 2007; de Bortoli et al , 2007). Collectively, the above reports as well as the present study all support the effectiveness of combining Lf-related products with specific antimicrobial agents for controlling the growth of pathogens.…”

The Effect of Proton Pump Inhibitors on the Human Microbiota

“…pylori infections are usually treated through a combination of two antibiotics and one PPI in so called "inhibitor-based triple therapies" [48]. However, antibiotic resistance is increasingly causing this therapy to be less effective [49]. PPIs are included in the treatment regiment of H. pylori infections because the efficacy of antibiotic drugs has been found to increase when intragastric acidity is decreased [50].…”

Effect of Byrsonima crassa and Phenolic Constituents on Helicobacter pylori-Induced Neutrophils Oxidative Burst

“…The most effective treatment is a combination of a proton pump inhibitor and antibiotics, but this fails to eradicate the infection in 10–20% of patients [6]. Non-antibiotic treatments, including phytomedicines, probiotics and antioxidants, have been increasingly investigated as potential alternatives for the treatment of H. pylori infection [7,8].…”