Treating Helicobacter pylori effectively while minimizing misuse of antibiotics

Abstract

Experts now recommend that all Helicobacter pylori infections be eradicated unless there are compelling reasons not to. As with other infectious diseases, effective therapy should be based on susceptibility.

FIGURE 1.

Nomogram of expected rates of cure (vertical axis) with triple therapy (ie, either clarithromycin or metronidazole, plus amoxicillin, plus a proton pump inhibitor) for Helicobacter pylori infection if the prevalence of resistance to clarithromycin or metronidazole in the population (horizontal axis) is 20% (A), 40% (B), or 8% (C). Even if the prevalence of resistance to the clarithromycin or metronidazole component of the regimen is 100% (far right side of graph), the amoxicillin and proton pump inhibitor components of the regimen can be expected to cure approximately 20% of cases. A cure rate of at least 90% is desirable. Based on Graham DY. Hp-normogram (normo-graham) for assessing the outcome of H. pylori therapy: effect of resistance, duration, and CYP2C19 genotype. Helicobacter 2015; 21:85–90.

FIGURE 2.

The “dirty little secret” of concomitant therapy (the combination of amoxicillin, metronidazole, clarithromycin, and a proton pump inhibitor) for Helicobacter pylori infection is a high rate of unnecessary antibiotic use. Shown are rates of unnecessary antibiotic use in a population with 20% clarithromycin resistance, 40% metronidazole resistance, and 8% dual resistance.