Review
Copyright ©The Author(s) 2015. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Pharmacol Ther. Nov 6, 2015; 6(4): 183-198
Published online Nov 6, 2015. doi: 10.4292/wjgpt.v6.i4.183
Antibiotic treatment for Helicobacter pylori: Is the end coming?
Su Young Kim, Duck Joo Choi, Jun-Won Chung
Su Young Kim, Duck Joo Choi, Jun-Won Chung, Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, Incheon 405-760, South Korea
Author contributions: Kim SY and Chung JW contributed equally to this work that designed and wrote the manuscript; Choi DJ collected the data.
Conflict-of-interest statement: No author has any personal or financial conflict of interest.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Jun-Won Chung, MD, PhD, Division of Gastroenterology, Department of Internal Medicine, Gachon University, Gil Medical Center, 21, Namdong-daero 774 beon-gil, Namdong-gu, Incheon 405-760, South Korea. junwonchung@daum.net
Telephone: +82-32-4603778 Fax: +82-32-4603408
Received: April 26, 2015
Peer-review started: April 27, 2015
First decision: July 25, 2015
Revised: September 7, 2015
Accepted: September 25, 2015
Article in press: September 28, 2015
Published online: November 6, 2015
Processing time: 200 Days and 4.2 Hours
Abstract

Infection with the Gram-negative pathogen Helicobacter pylori (H. pylori) has been associated with gastro-duodenal disease and the importance of H. pylori eradication is underscored by its designation as a group I carcinogen. The standard triple therapy consists of a proton pump inhibitor, amoxicillin and clarithromycin, although many other regimens are used, including quadruple, sequential and concomitant therapy regimens supplemented with metronidazole, clarithromycin and levofloxacin. Despite these efforts, current therapeutic regimens lack efficacy in eradication due to antibiotic resistance, drug compliance and antibiotic degradation by the acidic stomach environment. Antibiotic resistance to clarithromycin and metronidazole is particularly problematic and several approaches have been proposed to overcome this issue, such as complementary probiotic therapy with Lactobacillus. Other studies have identified novel molecules with an anti-H. pylori effect, as well as tailored therapy and nanotechnology as viable alternative eradication strategies. This review discusses current antibiotic therapy for H. pylori infections, limitations of this type of therapy and predicts the availability of newly developed therapies for H. pylori eradication.

Keywords: Helicobacter pylori; Treatment; Antibiotic resistance; Therapeutic regimens; Novel agents

Core tip: This article reviews the recent literature describing antibiotic resistance and trends in Helicobacter pylori (H. pylori) treatment. As there is no effective conventional therapy, new treatments are being developed and bismuth quadruple, sequential, concomitant therapies are recommended as a first-line regimen in regions with high levels of clarithromycin resistance. Quinolones have also been used for H. pylori treatment, although the cure rate has gradually reduced with this approach. New therapeutic directions include probiotic supplementation, tailored therapy, novel agents, and nanotechnology.