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.
Calvet
Xavier
X
Digestive Diseases Unit, Hospital de Sabadell, Institut Universitari Parc Taulí, Universitat Autònoma de Barcelona, Barcelona, Spain. xcalvet@cspt.es
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