Pharmacological considerations and step-by-step proposal for the treatment of Helicobacter pylori infection in the year 2018.

Pharmacological considerations and step-by-step proposal for the treatment of Helicobacter pylori infection in the year 2018. Minerva Gastroenterol Dietol. 2018 Mar 30;: Authors: Pellicano R, Zagari RM, Zhang S, Saracco GM, Moss SF Abstract Over the past 30 years, multidrug regimens consisting of a proton pump inhibitor (PPI) and two or three antibiotics have been used in treating Helicobacter pylori (H. pylori) infection. In clinical practice, the optimal regimen to cure H. pylori infection should be decided regionally. Considering the first treatment, the Maastricht V/Florence Consensus Report and the American College of Gastroenterology Clinical Management Guideline highlight that in countries with low clarithromycin resistance rates (<15%), an empiric clarithromycin-based regimen can be used. In countries with high clarithromycin resistance rates or, in the American Guideline, with a previous exposure to clarithromycin, a bismuth-containing quadruple therapy (with metronidazole and tetracycline) is the first choice. In case of persistent infection, after a previous clarithromycin-containing regimen, this drug should be avoided in second line therapy. Options after initial eradication failure include tailored therapy (choosing antibiotic combinations based on antibiotic susceptibility testing), empiric bismuth- containing quadruple therapy or triple levofloxacin-based therapy. Encouraging data are reported, both for the first-l...
Source: Minerva Gastroenterologica e Dietologica - Category: Gastroenterology Tags: Minerva Gastroenterol Dietol Source Type: research