title: Eradication of Helicobacter pylori infection.
abstract: Eradication of Helicobacter pylori infection has become an important issue recently, because this bacterial species cluster can cause many gastrointestinal diseases. Elevated antibiotic resistance is related to an increasing failure rate of H. pylori eradication. Standard triple therapy is still the first-line therapy; however, according to the Maastricht IV Consensus Report, it should be abandoned in areas of high clarithromycin resistance. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential, concomitant, and hybrid therapies. Quinolone-based triple therapy may be considered as first-line therapy in areas of clarithromycin resistance >15-20% and quinolone resistance <10%. Unique second-line therapy is still unclear, and bismuth-containing quadruple therapy or levofloxacin-based triple therapy can be used as rescue treatment. Third-line therapy should be under culture guidance to select the most effective regimens (such as levofloxacin-based, rifabutin-based, or furazolidone-based therapies). Antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports.
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Tzung-Shiun
authors.initials: TS
authors.lastname: Wu
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
authors.forename: Huang-Ming
authors.initials: HM
authors.lastname: Hu
authors.affiliation: School of Medicine, College of Medicine, I-Shou University, Kaohsiung, Taiwan.
authors.forename: Fu-Chen
authors.initials: FC
authors.lastname: Kuo
authors.affiliation: Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan; Department of Medicine, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan. Electronic address: kjh88kmu@gmail.com.
authors.forename: Chao-Hung
authors.initials: CH
authors.lastname: Kuo
mesh_terms: D060740:Disease Eradication; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000517:prevention & control; D006801:Humans
keywords: Bismuth-containing quadruple therapy; Helicobacter pylori infection; Rescue therapy; Standard triple therapy