Treatment of Helicobacter pylori infection: Current status and future concepts

Table 1 Treatment regimens proposed for the management of Helicobacter pylori infection in different geographic areas

Treatment	Asia-Pacific region[13]	Developing countries[14]	Europe[15]	United States[16]
First-line	Triple therapy	Triple therapy	Triple therapy	Triple therapy
	(PPI + CLA + AMO/MET)	(PPI + CLA + AMO/FUR)	(PPI-CLA-containing regimen)	(PPI + CLA + AMO/MET)
	BIS-based quadruple therapy	Quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy
	(PPI + BIS + MET + TET)	(PPI + CLA + AMO + BIS/MET or PPI + BIS + MET + TET)	(for high clarithromycin resistance)	(BIS + MET + TET + RAN)
			Sequential therapy	Sequential therapy
		Sequential therapy	(for high clarithromycin resistance)	(PPI + AMO and PPI + CLA + TIM)
		(PPI + AMO and PPI + CLA + NIT)
Second-line	BIS-based quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy
	(PPI + BIS + MET + TET)	(PPI + BIS + TET + MET/FUR)	LEV-based triple therapy	(PPI + TET + BIS + MET)
	LEV-based triple therapy	LEV-based triple therapy:		LEV-based triple therapy
	(PPI + LEV + AMO)	(PPI + LEV + BIS/FUR/AMO)		(PPI + AMO + LEV)
	RIF-based triple therapy
	(PPI + RIF + AMO)
Third-line	RIF-based triple therapy	LEV-based or FUR-based triple therapy	Guided by antimicrobial susceptibility testing
	(PPI + RIF + AMO)	(PPI + AMO + LEV/RIF or
		PPI + FUR + LEV)

AMO: Amoxicillin; BIS: Bismuth; CLA: Clarithromycin; FUR: Furazolidone; LEV: Levofloxacin; MET: Metronidazole; NIT: Nitronidazole; RAN: Ranitidine; RIF: Rifabutin; TET: Tetracycline; TIM: Timidazole; PPI: Proton pump inhibitor.

Table 2 Prevalence of antibiotic resistance in different regions[89,95,101-109]

	Africa	Asia	Europe	United States
Amoxicillin	17.8%	1.9%	0.5%	2.2%
Clarithromycin	13.4%	21.0%	11.1%	29.3%
Metronidazole	86.2%	38.1%	17.0%	44.1%
Levofloxacin	NA	14.0%	24.1%	NA

NA: Not available.

Table 3 Use of different high dose dual therapies for Helicobacter pylori infection

Author	Role	Regiment	Patients, n	Eradication rate
				ITT	PP	CYP2C19
						EM	IM	PM
Bayerdörffer et al[99]	1st	OME 40 mg and AMO 750 mg tid for 14 d	139	89.0%	90.6%
Miehlke et al[110]	2nd	OME 40 mg and AMO 750 mg qid for 14 d	41	75.6%	83.8%
Furuta et al[100]	2nd	RAB 10 mg and AMO 500 mg qid for 14 d	12		100.0%	100.0%	100%
Furuta et al[111]	2nd	LAN 30 mg and AMO 500 mg qid for 14 d	32		96.9%	95.7%	100%	100%
Shirai et al[112]	2nd	RAB 10 mg and AMO 500 mg qid	66	90.9%	93.8%
Graham et al[113]	1st	ESO 40 mg and AMO 750 mg tid for 7 d	36	72.2%	74.2%
Kim et al[114]	1st	LAN 30 mg and AMO 750 mg tid for 14 d	104	67.3%	78.4%
Goh et al[115]	2nd	RAB 20 mg and AMO 1 g tid for 14 d	149	71.8%	75.4%

ITT: Intention-to-treat; PP: Per-protocol; OME: Omeprazole; AMO: Amoxicillin; RAB: Rabeprazole; LAN: Lansoprazole; ESO: Esomeprazole; tid: Three times daily; qid: Four times daily; 1^st: First-line treatment; 2^nd: Rescue treatment; EM: Extensive metabolizer; IM: Intermediate metabolizer.