Treatment of Helicobacter pylori in Special Patient Populations

Abstract

Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First‐line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second‐line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first‐ and second‐line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc‐interval prolongation, and patients who are pregnant, breastfeeding, or elderly.

Helicobacter pylorifirst‐line and rescue treatments in patients allergic to penicillin: Experience from the European Registry onH pylorimanagement (Hp‐EuReg)

“…The treatment of H pylori in patients with penicillin allergy—a relatively frequent scenario—represents a significant challenge, as amoxicillin is one of the most effective antibiotics against this infection, and acquired resistance is rare 6 . Only few studies, including very low number of patients, have evaluated H pylori first‐line eradication treatments in patients with penicillin allergy (summarized in Table 4).…”

“…A history of penicillin allergy reported by the patient or general practitioner is common, often based on remote recollection without documentation. Moreover, the term “allergy” may be used by patients to denote any past adverse drug reaction 6,35 . Thus, it has been suggested that formal penicillin allergy testing may be done for the patients with a remote or unlikely history of allergy to determine whether they may be able to tolerate a penicillin or amoxicillin challenge 6,35 .…”

“…Moreover, the term “allergy” may be used by patients to denote any past adverse drug reaction 6,35 . Thus, it has been suggested that formal penicillin allergy testing may be done for the patients with a remote or unlikely history of allergy to determine whether they may be able to tolerate a penicillin or amoxicillin challenge 6,35 . Nevertheless, the aim of our study was to evaluate the efficacy of different treatments in patients allergic to penicillin, and not to assess the real frequency of this kind of antibiotic allergy.…”

Rabeprazole‐amoxicillin dual therapy as first‐line treatment for H pylori eradication in special patients: A retrospective, real‐life study

“…A 14‐day high‐dose dual therapy consisting of a standard or double dose of PPI and a total of 3 g/d amoxicillin was recommended as a salvage regimen for H pylori treatment in the ACG Clinical Guideline 37 . Given the ground of similar efficacy, 38 less pill exposure, lower risk of major drug interactions, and lower potential for AEs, amoxicillin‐based dual therapy may be considered as an alternative therapy in special patients 39 . In our study, a 14‐day dual regimen consisting of 10 mg rabeprazole and 1000 mg amoxicillin 3 times per day achieved a satisfactory eradication rate of 90.9% as the first‐line treatment.…”

Helicobacter pylori Infection in Geriatric Patients: Current Situation and Treatment Regimens

“…The elderly population is more likely to be resistant to antibiotics because of excessive use in the past ( 91 , 92 ). A multicenter cohort study showed that people aged >40 years were particularly at risk of developing dual drug resistance to levofloxacin and metronidazole ( 93 ).…”