Strategies to treat patients with antibiotic resistant Helicobacter pylori.
Increased resistance to clarithomycin and metronidazole, the two main antibiotics used to treat Helicobacter pylori infection, has led to a search for alternatives to the proton pump inhibitor based triple therapies commonly used. The main rescuse therapy is a bismuth-based quadruple therapy. However, triple therapies with tetracycline and metronidazole or amoxicillin and metronidazole can be considered in the case of clarithomycin resistance. They can also be used in the case of metronidazole resistance by increasing the dose and duration of metronidazole. The only therapy without clarithomycin and metronidazole includes rifabutin and amoxicillin. Dual therapies with amoxicillin and a proton pump inhibitor at high dose can also be used.
Mégraud
F
F
Laboratoire de Bactériologie, Hôpital Pellegrin, Place Amélie Raba-Léon, 33076 Bordeaux cedex, France. francis.megraud@chu-bordeaux.fr
D000658:Amoxicillin / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use*; D004352:Drug Resistance, Microbial; D004358:Drug Therapy / Q000379:methods; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008795:Metronidazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors; D013752:Tetracycline / Q000627:therapeutic use
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D013752:Tetracycline; D001729:Bismuth