Attempts to enhance the eradication rate of Helicobacter pylori infection.
Increasing rates of antimicrobial resistance to clarithromycin and metronidazole present challenges in maintaining optimal eradication rates. Knowledge of local antibiotic resistance and consumption pattern is important in selecting a reliable regimen. In addition, adverse effect profiles of therapeutic regimens are important and must be addressed to enhance compliance rates. Various methods of enhancing the eradication rates of Helicobacter pylori (H. pylori) have been investigated, including changing combinations or durations of established drugs, adding adjuvant drugs, or development of new molecules or agents. Bismuth-containing quadruple, sequential, concomitant, and levofloxacin-based triple therapies are replacing the long-standing standard of the triple regimen. Despite the encouraging results of these regimens, individualized approaches like treatment after antibiotics resistance test or CYP2C19 genotyping would be the mainstream of future therapy. Because scientific, economic, and technical problems make these advance therapies unfit for widespread use, future development for H. pylori therapy should be directed to overcome individualized antibiotic resistance. Although various novel regimens and additive agents have indicated favorable outcomes, more studies or validations are needed to become a mainstream H. pylori therapy.
Chang Seok Bang, Gwang Ho Baik, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea.
Chang Seok
CS
Bang
Chang Seok Bang, Gwang Ho Baik, Department of Internal Medicine, Hallym University College of Medicine, Chuncheon 200-704, South Korea.
Gwang Ho
GH
Baik
D000818:Animals; D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D001711:Biotransformation; D065731:Cytochrome P-450 CYP2C19 / Q000235:genetics / Q000378:metabolism; D004334:Drug Administration Schedule; D024901:Drug Resistance, Multiple, Bacterial; D004359:Drug Therapy, Combination; D005838:Genotype; D016481:Helicobacter Infections / Q000175:diagnosis / Q000188:drug therapy* / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000254:growth & development; D006801:Humans; D008826:Microbial Sensitivity Tests; D018579:Patient Selection; D010597:Pharmacogenetics; D010641:Phenotype; D057285:Precision Medicine; D011237:Predictive Value of Tests; D054328:Proton Pump Inhibitors / Q000008:administration & dosage* / Q000493:pharmacokinetics; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D054328:Proton Pump Inhibitors; C045793:CYP2C19 protein, human; D065731:Cytochrome P-450 CYP2C19
Antimicrobial drug resistance; Clarithromycin; Helicobacter pylori; Metronidazole; Microbial sensitivity tests