Regular review: Treatment of Helicobacter pylori infection

Boer, W. A. De; Tytgat, G. N. J.

doi:10.1136/bmj.320.7226.31

Cited by 174 publications

(151 citation statements)

References 19 publications

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“…As previously mentioned, it has been generally recommended that performing culture after a first eradication failure is not necessary, and therefore assessing H pylori sensitivity to antibiotics only after failure of the second treatment may be suggested in clinical practice [3,23,48,135] . However, the utility of the culture (with consequent antibiotic susceptibility testing) and the moment when it must be performed after eradication failure are both controversial [21] .…”

Section: Is It Necessary To Performmentioning

confidence: 99%

“…Rescue regimen after PPI-clarithromycin-nitroimidazole failure As previously mentioned, acquired bacterial resistance to metronidazole or clarithromycin results primarily from the previous treatment failure [26,32] , and therefore the first choice probably should not be a regimen that combines these two antibiotics in the same regimen [23,24,128] . Although this regimen is very effective [4] , patients who are not cured will probably have double resistance [26,129] , and no logical empirical treatment remains afterwards (although, more recently, the levofloxacin-based regimens may represent an option).…”

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“…Thus, some authors have demonstrated that initial regimens containing both clarithromycin and nitroimidazole are associated with significantly worse results overall, with lower eradication rates after logically chosen second-line therapy and sensitivity-directed third-line therapy; these poor results were due to the emergence of multiple resistant strains as evidenced by the results of culture testing after the second failed course [72] . In summary, due to problems with resistance it could be suggested that both key antibiotics-clarithromycin and metronidazole-should not be used together until a valid empirical back up regimen is available [23] . Nevertheless, if culture is not performed after failure of PPI-clarithromycin-metronidazole, and hence antibiotic susceptibility is unknown, several rescue options may be suggested.…”

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

“…Therefore, the evaluation of second or third rescue regimens for these problematic cases seems to be worthwhile. In designing a treatment strategy, we should not focus on the results of primary therapy alone; an adequate strategy for treating this infection should use several therapies which, if consecutively prescribed, come as close to the 100% cure rate as possible [20,21,23,24] . The aim of the present manuscript will be to review the experience dealing with "non-responders" to H pylori eradication therapy.…”

Section: Introductionmentioning

confidence: 99%

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“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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Helicobacter pylori (H pylori ) infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After more than 20 years of experience in H pylori treatment, in my opinion, the ideal regimen to treat this infection is still to be found. Currently, apart from having to know first-line eradication regimens well, we must also be prepared to face treatment failures. Therefore, in designing a treatment strategy we should not focus on the results of primary therapy alone, but also on the final (overall) eradication rate. The choice of a "rescue" treatment depends on which treatment is used initially. If a clarithromycinbased regimen was used initially, a subsequent metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacinbased combination would be a third "rescue" option. Alternatively, it has recently been suggested that levofloxacin-based rescue therapy constitutes an encouraging second-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, a quadruple regimen may be reserved as a third-line rescue option. Finally, rifabutin-based rescue therapy constitutes an encouraging empirical fourthline strategy after multiple previous eradication failures with key antibiotics such as amoxicillin, clarithromycin, metronidazole, tetracycline, and levofloxacin. Even after two consecutive failures, several studies have demonstrated that H pylori eradication can finally be achieved in almost all patients if several rescue therapies are consecutively given. Therefore, the attitude in H pylori eradication therapy failure, even after two or more unsuccessful attempts, should be to fight and not to surrender.

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Section: Is It Necessary To Performmentioning

confidence: 99%

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

Section: Rbc Tetracycline and Metronidazolementioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

“Rescue” regimens after Helicobacter pylori treatment failure

Gisbert¹

2008

WJG

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show abstract

“…For example, many ulcers are caused by bacteria and can be treated with antibiotics. 70 To fight bacteria, antibiotics target specific parts of their structure or machinery. While over 100 antibiotics are now available in the United States for use in treating human illness, most of the clinically important antibiotics fall into about a dozen classes of fairly similar compounds.…”

Section: Bacteria Antibiotics and Antibiotic Resistance-the Basics 68mentioning

confidence: 99%