title: Helicobacter pylori therapy: a paradigm shift.
abstract: Helicobacter pylori (H. Pylori) is a leading cause of gastroduodenal disease, including gastric cancer. H. pylori eradication therapies and their efficacy are summarized. A number of current treatment regimens will reliably yield >90% or 95% cure rates with susceptible strains. None has proven to be superior. We show how to predict the efficacy of a regimen in any population provided one knows the prevalence of antibiotic resistance. As with other infectious diseases, therapy should always be susceptibility-based. Susceptibility testing should be demanded. We provide recommendations for empiric therapies when that is the only option and describe how to distinguish studies providing misinformation from those providing reliable and interpretable data. When treated as an infectious disease, high H. pylori cure rates are relatively simple to reliably achieve.
authors.affiliation: a Department of Medicine , Michael E. DeBakey VA Medical Center and Baylor College of Medicine and Houston , Houston , TX , USA.
authors.forename: David Y
authors.initials: DY
authors.lastname: Graham
authors.affiliation: a Department of Medicine , Michael E. DeBakey VA Medical Center and Baylor College of Medicine and Houston , Houston , TX , USA.|b Dipartimento di Medicina Clinica e Sperimentale, Clinica Medica , University of Sassari , Sassari , Italy.
authors.forename: Maria Pina
authors.initials: MP
authors.lastname: Dore
mesh_terms: D000658:Amoxicillin / Q000008:administration & dosage / Q000592:standards; D000890:Anti-Infective Agents / Q000008:administration & dosage / Q000592:standards*; D001729:Bismuth / Q000008:administration & dosage / Q000592:standards; D017291:Clarithromycin / Q000008:administration & dosage / Q000592:standards; D024881:Drug Resistance, Bacterial; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy* / Q000453:epidemiology / Q000382:microbiology; D016480:Helicobacter pylori / Q000187:drug effects* / Q000302:isolation & purification; D006801:Humans; D008795:Metronidazole / Q000008:administration & dosage / Q000592:standards; D017410:Practice Guidelines as Topic; D054328:Proton Pump Inhibitors / Q000008:administration & dosage / Q000592:standards*; D059039:Standard of Care / Q000639:trends*; D016896:Treatment Outcome
chemical_list: D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D000658:Amoxicillin; D017291:Clarithromycin; D001729:Bismuth
keywords: Helicobacter pylori; amoxicillin; bismuth; clarithromycin; levofloxacin; metronidazole; proton pump inhibitor; tetracycline; therapy