Helicobacter pylori infection: treatment options.
After two decades of progress the best current approach to treatment of Helicobacter pylori infection is a strategy that combines two consecutive complementary treatments. Current guidelines recommend a first-line triple therapy - 7-10 days of a proton-pump inhibitor (PPI), clarithromycin and amoxicillin - followed by a quadruple therapy combining a PPI, metronidazole, tetracycline and a bismuth salt for treatment failures. Regrettably, present cure rates for first-line triple therapy are below 80%, and many patients require second-line treatment with further testing and control visits. Although most compliant patients are cured by the second-line treatment, patients often do not complete the full process and, as a result, final cure rates for the whole strategy often fall below 90%. This means that more effective first-line therapies are required. Promising recent developments include using quadruple therapy as first-line therapy, the use of adjuvant lactoferrin with triple therapy and a newly devised combination of a PPI, clarithromycin, amoxicillin and metronidazole, known as sequential treatment. Additional future developments will require the incorporation of new antibiotic weapons in the anti-H. pylori arsenal. The new quinolones and rifamycin derivates have recently demonstrated their efficacy in the treatment of H. pylori infection.
Digestive Diseases Unit, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain. xcalvet@cspt.es
Xavier
X
Calvet
D000890:Anti-Infective Agents / Q000627:therapeutic use*; D016481:Helicobacter Infections / Q000188:drug therapy*; D006801:Humans; D017410:Practice Guidelines as Topic; D016896:Treatment Outcome
D000890:Anti-Infective Agents