Treatment of Helicobacter pylori Infection 2014

Abstract

This review summarizes important studies regarding H.pylori therapy published from April 2013 to April 2014. The main themes that emerge are assessing the efficacy of standard triple therapy, as well as exploring new first-line treatments, predominantly optimized triple therapies and non-bismuth quadruple schemes. Regarding newer non-bismuth quadruple regimens, the compliance and tolerance seem to be similar for sequential and concomitant regimens. Notably, no study yet has demonstrated a clear statistical superiority for either, and a systematic review and meta-analysis may be warranted. Other studies examined the role of levofloxacin and bismuth based therapies in H. pylori eradication. The efficacy of bismuth as a second-line after sequential therapy was particularly noteworthy. Levofloxacin-based therapies also appear to be useful and versatile as part of different antibiotic combinations and in first-, second-, and third-line therapies. The emerging problem of quinolone resistance remains a worry. Individualized therapy, based on factors such as antimicrobial information, resistance data, and CYP2C19 metabolism, may well be the most notable future trend to emerge this year.

A novel chimeric flagellum fused with the multi-epitope vaccine CTB-UE prevents Helicobacter pylori-induced gastric cancer in a BALB/c mouse model

“…Seven-day triple therapy with a proton pump inhibitor (PPI), amoxicillin, and clarithromycin is the recommended first-line therapy for H. pylori eradication in most countries. However, the efficacy of this triple therapy is in decline because of increased antibiotic resistance (Vakil and Megraud 2007;Graham and Shiotani 2008;Papastergiou et al 2014;O'Connor et al 2014). The appearance of superbacteria has increased this concern, and developing a safe and effective therapy has become a common goal among scientists in this field.…”

Is There a Role for Probiotics in Helicobacter pylori Therapy?

“…20 Recently, O'Connor and associates observed that some probiotics, such as Lactobacilli and Bifidobacteria, exert an anti-H pylori effect in vitro and were helpful in reducing antibiotic-related side effects. 26 The most frequently studied agents have been Lactobacillus sp. strains.…”

Can probiotics improve efficiency and safety profile of triple Helicobacter pylori eradication therapy? A prospective randomized study

“…The rising resistance to clarithromycin requires the introduction of sequential or concomitant therapy as the first option, especially for the areas with high resistance to clarithromycin. Levofloxacin in combination with different antibiotics showed a good therapeutic effect as the first, second or third line therapy but arriving problem is the emergence of resistance to fluoroquinolones 5,6 . In a study from Japan newer fluoroquinolones sitafloxacin, which shows the lowest minimum inhibitory concentration for H. pylori, proved to be effective in combination with PPI, amoxicillin and metronidazole as third line therapy 7 .…”

“…Quadruple therapy with bismuth, like fluoroquinolones, has proved effective as a first line therapy or as rescue therapy. The main reason for the increased resistance to antibiotics is point mutations which accumulate in the H. pylori DNA 5 .…”