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World J Gastroenterol. May 14, 2014; 20(18): 5302-5307
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5302
Helicobacter pylori: Management in 2013
Yesim Ozen Alahdab, Cem Kalayci
Yesim Ozen Alahdab, Department of Gastroenterology and Hepatology, Fatih Sultan Mehmet Education and Research Hospital, 34752 Istanbul, Turkey
Cem Kalayci, Department of Gastroenterology and Hepatology, Feneryolu Mh Kadikoy, 34724 Istanbul, Turkey
Author contributions: Alahdab YO and Kalayci C contributed to this paper equally.
Correspondence to: Yesim Ozen Alahdab, MD, Department of Gastroenterology and Hepatology, Fatih Sultan Mehmet Education and Research Hospital, E5 Karayolu Uzeri Icerenkoy-Atasehir, 34752 Istanbul, Turkey. yesimalahdab@yahoo.com
Telephone: +90-532-7230290  Fax: +90-216-5750406
Received: September 30, 2013
Revised: November 25, 2013
Accepted: January 6, 2014
Published online: May 14, 2014
Abstract

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.

Keywords: Helicobacter pylori, First-line therapy, Second-line therapy, Rescue therapy

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.