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Review
. 2013 Nov-Dec;4(6):541-8.
doi: 10.4161/gmic.25930. Epub 2013 Aug 5.

Current recommendations for Helicobacter pylori therapies in a world of evolving resistance

Francis Mégraud  1
Affiliations
Review

Current recommendations for Helicobacter pylori therapies in a world of evolving resistance

Francis Mégraud. Gut Microbes. 2013 Nov-Dec.

Abstract

Occurrence of resistance, especially to clarithromycin, renders the standard triple therapy used to cure Helicobacter pylori infection ineffective. This review presents the bacteriological and pharmacological basis for H. pylori therapy and the current recommendations. The third-line treatment must be based on clarithromycin susceptibility testing. If the bacteria are still susceptible, failure may come from problems of compliance, hyperacidity or high bacterial load which can be overcome. If the bacteria are resistant, different regimens must be considered, including bismuth and non-bismuth-based quadruple therapies (sequential or concomitant), as well as triple therapies where amoxicillin is administered several times a day to obtain an optimal concentration at the gastric mucosal level. The treatments are becoming more and more complex and ecologically unsatisfactory, waiting for new agents or vaccines.

Keywords: antibiotics; clarithromycin; empiric treatment; eradication; mutation; quadruple therapy; tailored treatment; triple therapy.

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Figures

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Figure 1. Survival (A) and growth (B) of H. pylori according to pH.
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Figure 2. Long-term basal-to-apical (serosal-to-mucosal) transport of clarithromycin and amoxicillin across HT29–19A cell monolayers in cell culture inserts (mean ± s.d.).
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Figure 3. Therapies recommended for Helicobacter pylori eradication. Maastricht-4 Consensus Report.
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Figure 4.H. pylori eradication with Pylera®-omeprazole (10d) vs. standard clarithromycin-based triple therapy (7d) European Multicentric Study.
See this image and copyright information in PMC

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