title: Second and third line treatment options for Helicobacter pylori eradication.
abstract: Helicobacter pylori is a highly successful bacterium with a high global prevalence and the infection carries significant disease burden. It is also becoming increasingly difficult to eradicate and the main reason for this is growing primary antibiotic resistance rates in a world where antibiotics are frequently prescribed and readily available. Despite knowing much more about the bacterium since its discovery, such as its genomic makeup and pathogenesis, we have seen declining treatment success. Therefore, clinicians today must be prepared to face one, two or even multiple treatment failures, and should be equipped with sufficient knowledge to decide on the appropriate salvage therapy when this happens. This article discusses the factors contributing to treatment failure and reviews the second and third-line treatment strategies that have been investigated. Established empiric second line treatment options include both bismuth based quadruple therapy and levofloxacin based triple therapy. Antibiotic testing is recommended prior to initiating third line treatment. In the event that antibiotic susceptibility testing is unavailable, third line treatment options include rifabutin, rifaximin and sitafloxacin based therapies.
authors.affiliation: Mingjun Song, Tiing Leong Ang, Department of Gastroenterology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Mingjun
authors.initials: M
authors.lastname: Song
authors.affiliation: Mingjun Song, Tiing Leong Ang, Department of Gastroenterology, Changi General Hospital, Singapore 529889, Singapore.
authors.forename: Tiing Leong
authors.initials: TL
authors.lastname: Ang
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001729:Bismuth / Q000627:therapeutic use; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D024841:Fluoroquinolones / Q000627:therapeutic use; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D000077266:Moxifloxacin; D015242:Ofloxacin / Q000627:therapeutic use; D017828:Rifabutin / Q000627:therapeutic use; D012294:Rifamycins / Q000627:therapeutic use; D000078262:Rifaximin; D016879:Salvage Therapy; D037521:Virulence Factors
chemical_list: D000900:Anti-Bacterial Agents; D024841:Fluoroquinolones; D012294:Rifamycins; D037521:Virulence Factors; D008795:Metronidazole; D017828:Rifabutin; D064704:Levofloxacin; C076246:sitafloxacin; D015242:Ofloxacin; D000078262:Rifaximin; D001729:Bismuth; D000077266:Moxifloxacin
keywords: Bismuth; Drug resistance; Helicobacter pylori; Metronidazole; Microbial; Moxifloxacin; Ofloxacin; Rifabutin; Rifaximin; Salvage therapy; Sitafloxacin; Treatment failure