Current recommendations for Helicobacter pylori therapies in a world of evolving resistance.
Occurrence of resistance, especially to clarithromycin, renders the standard triple therapy used to cure Helicobacter pylori infection ineffective. This review presents the bacteriological and pharmacological basis for H. pylori therapy and the current recommendations. The third-line treatment must be based on clarithromycin susceptibility testing. If the bacteria are still susceptible, failure may come from problems of compliance, hyperacidity or high bacterial load which can be overcome. If the bacteria are resistant, different regimens must be considered, including bismuth and non-bismuth-based quadruple therapies (sequential or concomitant), as well as triple therapies where amoxicillin is administered several times a day to obtain an optimal concentration at the gastric mucosal level. The treatments are becoming more and more complex and ecologically unsatisfactory, waiting for new agents or vaccines.
INSERM U853; Bordeaux, France; Université de Bordeaux; Laboratoire de Bactériologie; Bordeaux, France.
Francis
F
Mégraud
D000658:Amoxicillin / Q000494:pharmacology; D000900:Anti-Bacterial Agents / Q000494:pharmacology*; D001729:Bismuth / Q000494:pharmacology; D017291:Clarithromycin / Q000494:pharmacology; D024881:Drug Resistance, Bacterial; D036262:Empirical Research; D005753:Gastric Mucosa / Q000187:drug effects / Q000378:metabolism; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D000658:Amoxicillin; D017291:Clarithromycin; D001729:Bismuth
antibiotics; clarithromycin; empiric treatment; eradication; mutation; quadruple therapy; tailored treatment; triple therapy