[Treatment of Helicobacter pylori infection]

Abstract

The clarithromycin-based triple therapy should not yet be prescribed as probabilistic first-line treatment in France. The sequential therapy should be recommended as first-line regimen. The empirical antibiotic therapy with a quadruple association PPI, tetracycline, metronidazole and bismuth is the most interesting alternative, particularly in patients allergic to beta-lactams or having previously received macrolides regardless of the indication. After the treatment, the control must be systematic, 4 weeks after stopping antibiotics and 15 days after stopping PPI. After failure to eradicate H. pylori in the absence of strain isolation, antibiotics already used in previous combination therapy should not be re-prescribed. After two eradication failures, endoscopy with bacterial isolation and determination of antibiotic sensiitivity to clarithromycin and levofloxacin are needed to guide a rescue treatment.