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World J Gastroenterol. May 21, 2014; 20(19): 5654-5659
Published online May 21, 2014. doi: 10.3748/wjg.v20.i19.5654
Optimal treatment strategy for Helicobacter pylori: Era of antibiotic resistance
Jun Heo, Seong Woo Jeon
Jun Heo, Seong Woo Jeon, Department of Internal Medicine, Kyungpook National University Hospital Medical Center, Daegu 702-911, South Korea
Author contributions: Heo J and Jeon SW solely contributed to this paper.
Correspondence to: Seong Woo Jeon, MD, PhD, Department of Internal Medicine, Kyungpook National University Hospital Medical Center, 807, Hokuk-Ro, Book-Gu, Daegu 702-911, South Korea. sw-jeon@hanmail.net
Telephone: +82-53-2003517 Fax: +82-53-2002027
Received: September 27, 2013
Revised: November 29, 2013
Accepted: February 20, 2014
Published online: May 21, 2014
Processing time: 232 Days and 19.3 Hours
Abstract

Standard triple therapy, consisting of a proton pump inhibitor, plus amoxicillin and clarithromycin, has been the most commonly used first-line treatment regimen for Helicobacter pylori (H. pylori) eradication for many years worldwide. However, as a result of increased resistance to antibiotics, H. pylori eradication rates with use of standard triple therapy have been declining and recently reached < 80% in many countries. Several new strategies to enhance the eradication rate of H. pylori have been studied. Currently, among the alternative first-line eradication regimens, concomitant and hybrid regimens have shown excellent results and could be the optimal treatment option. Although clinical usefulness of rescue therapy for patients in whom eradication of H. pylori with non-bismuth quadruple regimen has failed is unclear, levofloxacin-based quadruple therapy has shown promise as a rescue treatment. The choice of third-line therapy depends on factors such as the local pattern of antibiotic resistance, drug availability, and previous treatment. We hope that a simple method for detection of antibiotic susceptibility using polymerase chain reaction would be a possible alternative to administration of “tailored treatment” in the era of increasing prevalence of antimicrobial resistance.

Keywords: Helicobacter pylori; Standard therapy; Bacterial eradication; Concomitant therapy; Hybrid therapy

Core tip: Currently, among the alternative first-line eradication regimens, concomitant and hybrid regimens have shown excellent results and could be the optimal treatment option. Levofloxacin-based quadruple therapy has shown promise as a rescue treatment.