Treatment ofHelicobacter pyloriinfection: Current status and future concepts

Abstract

Helicobacter pylori (H. pylori) infection is highly associated with the occurrence of gastrointestinal diseases, including gastric inflammation, peptic ulcer, gastric cancer, and gastric mucosa-associated lymphoid-tissue lymphoma. Although alternative therapies, including phytomedicines and probiotics, have been used to improve eradication, current treatment still relies on a combination of antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, and levofloxacin, and antisecretory agents, such as proton pump inhibitors (PPIs). A standard triple therapy consisting of a PPI and two antibiotics (clarithromycin and amoxicillin/metronidazole) is widely used as the first-line regimen for treatment of infection, but the increased resistance of H. pylori to clarithromycin and metronidazole has significantly reduced the eradication rate using this therapy and bismuth-containing therapy or 10-d sequential therapy has therefore been proposed to replace standard triple therapy. Alternatively, levofloxacin-based triple therapy can be used as rescue therapy for H. pylori infection after failure of first-line therapy. The increase in resistance to antibiotics, including levofloxacin, may limit the applicability of such regimens. However, since resistance of H. pylori to amoxicillin is generally low, an optimized high dose dual therapy consisting of a PPI and amoxicillin can be an effective first-line or rescue therapy. In addition, the concomitant use of alternative medicine has the potential to provide additive or synergistic effects against H. pylori infection, though its efficacy needs to be verified in clinical studies.

High-dose Dual Therapy Is Superior to Standard First-line or Rescue Therapy for Helicobacter pylori Infection

“…2,16 However, the high reported resistance rates of CLA and MTZ significantly reduces the efficacy of these regimens. 5,6,17 To improve the treatment outcome, it is therefore important to use antibiotics, such as AMO, that have low resistance rates to H. pylori .…”

Resistance Rate and Minimum Inhibitory Concentration of Metronidazole Among Helicobacter pylori Strains in Tehran, Iran

“…Similarly, the collected data showed an increasing trend of resistance to metronidazole in the recent years in Iran (94%) (9). Eradication rate of triple therapy regimens was found as 97% in metronidazole-susceptible strains, which was much higher than the value for the metronidazoleresistant strains (72.6%) (10). According to the latest guideline for H. pylori medication, the prescribed regimens should be selected based on resistance of H. pylori strains to metronidazole and clarithromycin in each geographic region (11).…”

Systematic review and meta-analysis: Multi-strain probiotics as adjunct therapy forHelicobacter pylorieradication and prevention of adverse events

“…4 Treatment with triple therapy (two antibiotics and a proton-pump inhibitor (PPI)) has lost efficacy (now ranging from 71-81%) due to the development of antibiotic resistance in many parts of the world (ranging from 11-63% for clarithromycin, 17-86% for metronidazole, and 14-24% for levofloxacin). [5][6][7][8] To overcome the development of antibiotic resistance, newer strategies using sequential or concomitant quadruple regimes (adding either another antibiotic or bismuth-subcitrate) have resulted in improved H. pylori eradication rates (85-92%). [9][10][11][12] However, some newer quadruple combinations still result in a high frequency of side-effects (23% for sequential therapies and 46% for concomitant therapies).…”