Treatment ofHelicobacter pyloriinfection: Past, present and future

Abstract

Helicobacter pylori (H. pylori) is a major human pathogen associated with significant morbidity and mortality. However, after decades of efforts, treatment of H. pylori remains a challenge for physicians, as there is no universally effective regimen. Due to the rising prevalence of antimicrobial resistance, mainly to clarithromycin, efficacy of standard triple therapies has declined to unacceptably low levels in most parts of the world. Novel regimens, specifically experimented to improve the therapeutic outcome against antibiotic-resistant H. pylori strains, are now recommended as first-line empirical treatment options providing high efficacy (reportedly > 90% in intention to treat analysis) even in high clarithromycin resistance settings. These include the bismuth quadruple, concomitant, sequential and hybrid therapies. Due to the rapid development of quinolone resistance, levofloxacin-based regimens should be reserved as second-line/rescue options. Adjunct use of probiotics has been proposed in order to boost eradication rates and decrease occurrence of treatment-related side effects. Molecular testing methods are currently available for the characterization of H. pylori therapeutic susceptibility, including genotypic detection of macrolide resistance and evaluation of the cytochrome P450 2C19 status known to affect the metabolism of proton pump inhibitors. In the future, use of these techniques may allow for culture-free, non-invasive tailoring of therapy for H. pylori infection.

Antibiotic treatment forHelicobacter pylori: Is the end coming?

“…Modifications in the rdxA gene, assumed to be point mutations, are considered a primary cause [30] . Metronidazole resistance may also influence the treatment outcome, although it is generally considered less clinically important than clarithromycin resistance [52,53] . Overall, the Eastern Asian region has higher metronidazole resistance rates with 95.4% in the southeast coastal region of China [39] and 71.3% in Japan [37] .…”

“…Bismuth quadruple therapy (bismuth subcitrate potassium, metronidazole, tetracycline, PPI) has been suggested as a first-line treatment option for regions with a high (> 20%) incidence of clarithromycin resistance [53] .…”

“…There have been several studies of levofloxacin use as a first-line treatment [112] . To overcome increasing clarithromycin resistance, levofloxacin has been used as a alternative to clarithromycin in either STT or sequential therapy [53] . Table 4 shows H. pylori eradication rates following levofloxacin-containing therapy.…”

Current Status of H. pylori Infection Treatment 2017

“…Standard regimen such as clarithromycin plus proton pump inhibitor (PPI) plus amoxicillin or metronidazole for 7, 10 and 14 days is worldwide followed by first-line treatment regimen. It has revealed that PPI-based triple regimen which provided eradication rates greater than 80-90%, usually consisting of a PPI, amoxicillin, and clarithromycin (Papastergiou et al, 2014). The recent national survey reported that the eradication rate of triple therapy, which is 84.92-87.50% from 2001 to 2007, but 80-81.43% from 2008 to 2010 (Sherief et al, 2016).Review studies have shown that eradication rate is highest using amoxicillin with PPI and clarithromycin (83.50%) than metronidazole 68.64% as well as PPI, amoxicillin, and metronidazole the rate 82%; each therapy lasting 14 days (Ermis et al, 2015).…”

“…But standard triple therapy has been recently declined efficacy due to antibiotic resistance resulting decreased eradication rates. Bismuth quadruple, concomitant, sequential and levofloxacin therapies are currently better than standard therapy that is providing promoted efficacy (Ermis et al, 2015;Papastergiou et al, 2014;Benjamin et al, 2010). Therefore, this study major purposed to provide a reconsideration modern beneficial efficacy of the drug and better eradication rates of H. pylori infection.…”