Treatment of Helicobacter pylori infection: current status and future concepts.
Helicobacter pylori (H. pylori) infection is highly associated with the occurrence of gastrointestinal diseases, including gastric inflammation, peptic ulcer, gastric cancer, and gastric mucosa-associated lymphoid-tissue lymphoma. Although alternative therapies, including phytomedicines and probiotics, have been used to improve eradication, current treatment still relies on a combination of antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, and levofloxacin, and antisecretory agents, such as proton pump inhibitors (PPIs). A standard triple therapy consisting of a PPI and two antibiotics (clarithromycin and amoxicillin/metronidazole) is widely used as the first-line regimen for treatment of infection, but the increased resistance of H. pylori to clarithromycin and metronidazole has significantly reduced the eradication rate using this therapy and bismuth-containing therapy or 10-d sequential therapy has therefore been proposed to replace standard triple therapy. Alternatively, levofloxacin-based triple therapy can be used as rescue therapy for H. pylori infection after failure of first-line therapy. The increase in resistance to antibiotics, including levofloxacin, may limit the applicability of such regimens. However, since resistance of H. pylori to amoxicillin is generally low, an optimized high dose dual therapy consisting of a PPI and amoxicillin can be an effective first-line or rescue therapy. In addition, the concomitant use of alternative medicine has the potential to provide additive or synergistic effects against H. pylori infection, though its efficacy needs to be verified in clinical studies.
Jyh-Chin Yang, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
Jyh-Chin
JC
Yang
Jyh-Chin Yang, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
Chien-Wei
CW
Lu
Jyh-Chin Yang, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan.
Chun-Jung
CJ
Lin
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D000529:Complementary Therapies; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D006801:Humans; D017410:Practice Guidelines as Topic; D019936:Probiotics / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D013997:Time Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
Antimicrobial agents; Campylobacter pyloridis; Helicobacter pylori; Proton pump inhibitor