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Review
. 2016 Jun;14(6):577-85.
doi: 10.1080/14787210.2016.1178065. Epub 2016 May 3.

Helicobacter pylori therapy: a paradigm shift

David Y Graham  1 , Maria Pina Dore  1   2
Affiliations
Review

Helicobacter pylori therapy: a paradigm shift

David Y Graham et al. Expert Rev Anti Infect Ther. 2016 Jun.

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.

Keywords: Helicobacter pylori; amoxicillin; bismuth; clarithromycin; levofloxacin; metronidazole; proton pump inhibitor; tetracycline; therapy.

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Figures

Figure 1
Figure 1
Intention to treat cure rates and standard deviation reported for the clinical trials done to obtain US Food and Drug Administration approval for PPI, clarithromycin, amoxicillin triple in the United States [26-29].
Figure 2
Figure 2
H. pylori nomogram. This nomogram plots the cure rate with susceptible infections on the left vertical axis and those with resistant infections on the right vertical axis. The proportion with resistance is shown on the horizontal axis [43]. The cure rates with 100% susceptible and 100% clarithromycin resistant are connected with a line allowing one to visualize the population cure rates for any prevalence of resistance. This plot shows the cure rates with a 14 day PPI, clarithromycin, amoxicillin triple therapy in a western population in relation to the prevalence of clarithromycin resistance. It also illustrates the expected cure rate, per protocol, expected with a prevalence of clarithromycin resistance of 20%.
See this image and copyright information in PMC

References

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    1. Graham DY. Helicobacter pylori update: Gastric cancer, reliable therapy, and possible benefits. Gastroenterology. 2015;148:719–731. *Up to date review of the role of H. pylori in gastric cancer, H. pylori therapy, and review of its possible role in myocardial infarction, gastroesophageal reflux disease, childhood asthma, and obesity.

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