Helicobacter pylori: management in 2013.
Helicobacter pylori (H. pylori) is a prevalent, worldwide, chronic infection. Choice of treatment can be modified according to antibiotic-resistance rates of H. pylori. The ideal therapeutic regimen for H. pylori infection should achieve an eradication rate of ≥ 80%. In some countries, triple therapy with a proton-pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole is still the best option. Bismuth-containing quadruple therapy consisting of bismuth salts, tetracycline, metronidazole and PPI, may be the preferred option in countries with clarithromycin resistance > 20%. Sequential therapy including a PPI and amoxicillin given for the first 5 d, followed by triple therapy including a PPI, clarithromycin, and nitroimidazole antimicrobial (all twice daily) for the remaining 5 d, can be another option for the first-line treatment of H. pylori. Recent data suggest that treatment with PPI, levofloxacin, and amoxicillin for 10 d is a good choice for second-line therapy. Concomitant therapy consisting of PPI, amoxicillin, clarithromycin and metronidazole is another option for second-line treatment. If second-line treatment also fails, it is recommended to culture H. pylori from biopsy specimens and perform antimicrobial susceptibility testing. Rescue treatment should be based on antimicrobial susceptibility.
Yesim Ozen Alahdab, Department of Gastroenterology and Hepatology, Fatih Sultan Mehmet Education and Research Hospital, 34752 Istanbul, Turkey.
Yesim Ozen
YO
Alahdab
Yesim Ozen Alahdab, Department of Gastroenterology and Hepatology, Fatih Sultan Mehmet Education and Research Hospital, 34752 Istanbul, Turkey.
Cem
C
Kalayci
D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development / Q000472:pathogenicity; D006801:Humans; D008826:Microbial Sensitivity Tests; D018579:Patient Selection; D010597:Pharmacogenetics; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage*; D012307:Risk Factors; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors
First-line therapy; Helicobacter pylori; Rescue therapy; Second-line therapy