Helicobacter pylori: diagnosis and treatment.
OBJECTIVE
Multiple diagnostic methods and treatment strategies have been developed to detect and treat the Helicobacter pylori infection. Many of them have stood the test of time; others lost their value with the introduction of new test and treatment modalities. This review focuses on the current diagnostic methods and their clinical implications, as well as on established and novel treatment strategies.


RESULTS
The increasing antimicrobial resistance has resulted in a decline of the success rate of recommended eradication regimens. The current guidelines recommend as first-line treatment clarithromycin, amoxicillin or metronidazole, and proton pump inhibitor twice daily, but recent studies have demonstrated an increasing eradication failure with these regimens. Several treatment modifications have been adopted regarding duration and combination of substances.


CONCLUSIONS
The currently recommended first-line treatments are effective and well tolerated. In areas with high antimicrobial resistance rates, new antibiotic combinations and modifications in the sequence of drug administration are proposed as alternative treatment options to standard triple therapy. Future treatment strategies have to focus on regional antimicrobial resistance adopted treatment selection and the development of new antibiotics.
Selgrad
Michael
M
Department of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University Magdeburg, Magdeburg, Germany.
Kandulski
Arne
A
Malfertheiner
Peter
P
D000658:Amoxicillin / Q000008:administration & dosage; D001729:Bismuth / Q000008:administration & dosage; D017291:Clarithromycin / Q000008:administration & dosage; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000008:administration & dosage; D016481:Helicobacter Infections / Q000175:diagnosis* / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage; D015242:Ofloxacin / Q000008:administration & dosage; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage; D017828:Rifabutin / Q000008:administration & dosage; D017211:Treatment Failure
D024841:Fluoroquinolones; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D017828:Rifabutin; D000658:Amoxicillin; D015242:Ofloxacin; D017291:Clarithromycin; D001729:Bismuth