Treatment of Helicobacter pylori infection in 2018

Abstract

Treatment options for the eradication of Helicobacter pylori continue to evolve. There have been many guidelines for H. pylori treatment published, which may lead to some confusion. However, most are in agreement with the most recent iteration of the Maastricht treatment guidelines. Triple therapy is still the most frequently used treatment, especially in areas of low clarithromycin resistance. Its best results are achieved when taken for a minimum of 10 days and with high-dose acid suppression. Quadruple therapy is gaining in popularity particularly in areas with increasing resistance to standard triple therapy. Whether three antibiotics, or bismuth and two antibiotics are used, excellent eradication rates are achieved, albeit with increased side effects. Levofloxacin second-line therapy is widely used; however bismuth, when available, is an increasingly successful option. Sequential therapy is challenging in terms of compliance and is no longer recommended. This past year witnessed a notable increase in the number of studies based on antimicrobial susceptibility testing and tailored eradication therapy, reflecting the role of culture-guided treatment, which may well represent the future of H. pylori treatment and prevent the inappropriate use of antibiotics.

Intraluminal therapy for Helicobacter pylori infection

“…5,6 This is attributable to the special gastric milieu of H. pylori, which leads to more difficult and complicated treatment regimens to achieve its successful eradication in contrast to other bacterial infections. Several strategies [7][8][9] have been proposed to increase the eradication rate and decrease the antibiotic resistance, including extension of treatment duration, increasing doses, using four-drug nonbismuth-containing (sequential, hybrid, and concomitant) and bismuth-containing quadruple therapies or even five-drug quintuple therapy, 10 use of other antibiotics such as levofloxacin, 9 azithromycin, 11 rifabutin, 12,13 and furazolidone, 14 using a high-dose proton pump inhibitor 15 or a novel potassium-competitive acid blocker (vonoprazan), [16][17][18] dual therapy, 8 use of bismuth-enhanced triple therapy 19 or susceptibility-guided therapy, [20][21][22] and the supplementation of probiotics. 8,23,24 However, the current multiple-dose antibiotic therapies still steadily increase the rate of worldwide antibiotic resistance, which becomes a leading international medical problem.…”

Flavodoxins as Novel Therapeutic Targets against Helicobacter pylori and Other Gastric Pathogens

“…In fact, clarithromycin-resistant Hp strains were included by the World Health Organization in the high-priority group of pathogens that urgently require novel treatments [20]. Additional therapeutic regimens have been proposed that include the use of vonoprazan, furazolidone, rifabutin, fluoroquinolones, and probiotics-containing treatments [12,13,15,21,22]. Recent works suggest that therapies against Hp should be adapted to local antibiotic resistances, and the Maastrich V/Florence consensus report recommended, after failure of second-line treatment, culture with susceptibility testing or molecular determination of genotype resistance [13,15,[21][22][23].…”

“…Additional therapeutic regimens have been proposed that include the use of vonoprazan, furazolidone, rifabutin, fluoroquinolones, and probiotics-containing treatments [12,13,15,21,22]. Recent works suggest that therapies against Hp should be adapted to local antibiotic resistances, and the Maastrich V/Florence consensus report recommended, after failure of second-line treatment, culture with susceptibility testing or molecular determination of genotype resistance [13,15,[21][22][23]. While prophylactic or therapeutic vaccines for Hp have been investigated, no vaccine has been developed yet, probably because of high Hp genetic variability together with the fact that the infection downregulates the host's immune response which highlights the importance of selecting Hp antigens and adjuvants capable of triggering a strong host immune reaction [24,25].…”

Gastric hyperplastic polyps inversely associated with current Helicobacter�pylori infection

“…Treatment of H. pylori infection-associated diseases is a complex problem. The most widely recommended regimen is a triple therapy comprising one proton pump inhibitor (PPI) and two antibiotics (8).…”