title: Eradication of Helicobacter pylori infection: which regimen first?
abstract: Helicobacter pylori (H. pylori) is a well-known human pathogen that plays an essential role in the pathogenesis of chronic gastritis, peptic ulcer disease, and gastric malignancies. Although H. pylori is susceptible to several antimicrobials, this infection has proven challenging to cure because of the increasing prevalence of bacterial strains that are resistant to the most commonly used antimicrobials, particularly clarithromycin. An effective (i.e., > 90%) first-line therapy is mandatory for avoiding supplementary treatments and testing, and more importantly for preventing the development of secondary resistance. This study reviews the recent literature on first-line therapies for H. pylori. The eradication rates following standard triple therapy (a proton pump inhibitor plus amoxicillin and clarithromycin) for H. pylori infection are declining worldwide. Several first-line strategies have been proposed to increase the eradication rate, including extending the treatment duration to 14 d, the use of a four-drug regimen (bismuth-containing quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as fluoroquinolones. However, the efficacy of these regimens is controversial. A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region.
authors.affiliation: Alessandro Federico, Antonietta Gerarda Gravina, Agnese Miranda, Carmela Loguercio, Marco Romano, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Federico
authors.affiliation: Alessandro Federico, Antonietta Gerarda Gravina, Agnese Miranda, Carmela Loguercio, Marco Romano, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Antonietta Gerarda
authors.initials: AG
authors.lastname: Gravina
authors.affiliation: Alessandro Federico, Antonietta Gerarda Gravina, Agnese Miranda, Carmela Loguercio, Marco Romano, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Agnese
authors.initials: A
authors.lastname: Miranda
authors.affiliation: Alessandro Federico, Antonietta Gerarda Gravina, Agnese Miranda, Carmela Loguercio, Marco Romano, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Carmela
authors.initials: C
authors.lastname: Loguercio
authors.affiliation: Alessandro Federico, Antonietta Gerarda Gravina, Agnese Miranda, Carmela Loguercio, Marco Romano, Department of Clinical and Experimental Medicine, Gastroenterology Unit, Second University of Naples, 80131 Naples, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Romano
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D005756:Gastritis / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000472:pathogenicity; D006801:Humans; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000627:therapeutic use*; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
keywords: Clarithromycin; Concomitant therapy; Helicobacter pylori; Hybrid therapy; Levofloxacin; Sequential therapy