title: Optimal treatment strategy for Helicobacter pylori: era of antibiotic resistance.
abstract: Standard triple therapy, consisting of a proton pump inhibitor, plus amoxicillin and clarithromycin, has been the most commonly used first-line treatment regimen for Helicobacter pylori (H. pylori) eradication for many years worldwide. However, as a result of increased resistance to antibiotics, H. pylori eradication rates with use of standard triple therapy have been declining and recently reached < 80% in many countries. Several new strategies to enhance the eradication rate of H. pylori have been studied. Currently, among the alternative first-line eradication regimens, concomitant and hybrid regimens have shown excellent results and could be the optimal treatment option. Although clinical usefulness of rescue therapy for patients in whom eradication of H. pylori with non-bismuth quadruple regimen has failed is unclear, levofloxacin-based quadruple therapy has shown promise as a rescue treatment. The choice of third-line therapy depends on factors such as the local pattern of antibiotic resistance, drug availability, and previous treatment. We hope that a simple method for detection of antibiotic susceptibility using polymerase chain reaction would be a possible alternative to administration of "tailored treatment" in the era of increasing prevalence of antimicrobial resistance.
authors.affiliation: Jun Heo, Seong Woo Jeon, Department of Internal Medicine, Kyungpook National University Hospital Medical Center, Daegu 702-911, South Korea.
authors.forename: Jun
authors.initials: J
authors.lastname: Heo
authors.affiliation: Jun Heo, Seong Woo Jeon, Department of Internal Medicine, Kyungpook National University Hospital Medical Center, Daegu 702-911, South Korea.
authors.forename: Seong Woo
authors.initials: SW
authors.lastname: Jeon
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004334:Drug Administration Schedule; D024881:Drug Resistance, Bacterial; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori / Q000187:drug effects*; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008826:Microbial Sensitivity Tests; D016133:Polymerase Chain Reaction; D054328:Proton Pump Inhibitors / Q000627:therapeutic use; D016896:Treatment Outcome
chemical_list: D054328:Proton Pump Inhibitors; D064704:Levofloxacin; D000658:Amoxicillin; D017291:Clarithromycin; D001729:Bismuth
keywords: Bacterial eradication; Concomitant therapy; Helicobacter pylori; Hybrid therapy; Standard therapy