Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2014 Aug 7;20(29):9898-911.
doi: 10.3748/wjg.v20.i29.9898.

Treatment of Helicobacter pylori infection: meeting the challenge of antimicrobial resistance

Vasilios Papastergiou  1 , Sotirios D Georgopoulos  1 , Stylianos Karatapanis  1
Affiliations
Review

Treatment of Helicobacter pylori infection: meeting the challenge of antimicrobial resistance

Vasilios Papastergiou et al. World J Gastroenterol. .

Abstract

Treatment of Helicobacter pylori (H. pylori) infection is paramount for the management of prevalent gastrointestinal disorders including peptic ulcer disease and gastric cancer. Due to the wide increase in prevalence of H. pylori resistance to antibiotics, clarithromycin-based triple therapies are not any more suitable for unconditional empiric use, and should not be recommended, unless local resistance to this antibiotic is low (< 20%). Alternative strategies have been proposed to overcome the issue of increasing clarithromycin resistance, and some of them are already implemented in clinical practice. These comprise: (1) adoption of novel, more effective, empirical treatments: bismuth quadruple, sequential, non-bismuth quadruple (concomitant), dual-concomitant (hybrid), and levofloxacin-based regimens, the latter mainly designated as second-line/rescue options; (2) perspectives for a susceptibility-guided (tailored) therapeutic approach based on culture-free molecular testing methods; and (3) adjunct use of probiotics to improve eradication rates. The present article is aimed to provide a comprehensive overview of current and emerging strategies in the treatment of H. pylori infection, focusing on the challenge of antimicrobial resistance.

Keywords: Antibiotic resistance; Bismuth-quadruple; Concomitant; Helicobacter pylori; Sequential.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Continental rates of Helicobacter pylori resistance to clarithromycin, metronidazole and levofloxacin.
See this image and copyright information in PMC

References

    1. Moayyedi P, Hunt RH. Helicobacter pylori public health implications. Helicobacter. 2004;9 Suppl 1:67–72. - PubMed
    1. Malfertheiner P, Chan FK, McColl KE. Peptic ulcer disease. Lancet. 2009;374:1449–1461. - PubMed
    1. Kuipers EJ. Helicobacter pylori and the risk and management of associated diseases: gastritis, ulcer disease, atrophic gastritis and gastric cancer. Aliment Pharmacol Ther. 1997;11 Suppl 1:71–88. - PubMed
    1. Schistosomes , liver flukes and Helicobacter pylori. IARC Working Group on the Evaluation of Carcinogenic Risks to Humans. Lyon, 7-14 June 1994. IARC Monogr Eval Carcinog Risks Hum. 1994;61:1–241. - PubMed
    1. Zhao B, Zhao J, Cheng WF, Shi WJ, Liu W, Pan XL, Zhang GX. Efficacy of Helicobacter pylori eradication therapy on functional dyspepsia: a meta-analysis of randomized controlled studies with 12-month follow-up. J Clin Gastroenterol. 2014;48:241–247. - PubMed

MeSH terms

Substances