Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5302
Revised: November 25, 2013
Accepted: January 6, 2014
Published online: May 14, 2014
Processing time: 227 Days and 6.4 Hours
Helicobacter pylori (H. pylori) is a prevalent, worldwide, chronic infection. Choice of treatment can be modified according to antibiotic-resistance rates of H. pylori. The ideal therapeutic regimen for H. pylori infection should achieve an eradication rate of ≥ 80%. In some countries, triple therapy with a proton-pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole is still the best option. Bismuth-containing quadruple therapy consisting of bismuth salts, tetracycline, metronidazole and PPI, may be the preferred option in countries with clarithromycin resistance > 20%. Sequential therapy including a PPI and amoxicillin given for the first 5 d, followed by triple therapy including a PPI, clarithromycin, and nitroimidazole antimicrobial (all twice daily) for the remaining 5 d, can be another option for the first-line treatment of H. pylori. Recent data suggest that treatment with PPI, levofloxacin, and amoxicillin for 10 d is a good choice for second-line therapy. Concomitant therapy consisting of PPI, amoxicillin, clarithromycin and metronidazole is another option for second-line treatment. If second-line treatment also fails, it is recommended to culture H. pylori from biopsy specimens and perform antimicrobial susceptibility testing. Rescue treatment should be based on antimicrobial susceptibility.
Core tip:Helicobacter pylori (H. pylori) is a prevalent, worldwide, chronic infection. The ideal therapy regimen for H. pylori infection should achieve an eradication rate ≥ 80%. Triple therapy remains an appropriate first-line therapy in areas of low clarithromycin resistance, and quadruple therapy should be the first-line therapy in areas of high clarithromycin resistance. Sequential therapy can be an alternative. Levofloxacin-containing regimens or concomitant therapies can be good choices for second-line therapy. Choice of treatment regimen for H. pylori infection should be done cautiously and antibiotic-resistance rates should be taken into consideration.