From the Research
Introduction to Helicobacter pylori (H. pylori) Treatment
Helicobacter pylori infection is a significant health issue worldwide, and its treatment has become more challenging due to increasing antimicrobial resistance 1, 2. The choice of H. pylori eradication regimen should be based on the local prevalence of clarithromycin resistance and the previous use of macrolides.
First-Line Treatment Options
The recommended first-line treatment regimens for H. pylori infection include:
- Quadruple therapies (bismuth quadruple and concomitant) 1, 2
- A 14-day clarithromycin-containing triple therapy in areas with low prevalence of clarithromycin resistance and in patients without previous use of macrolides 1
Second-Line Treatment Options
Second-line treatments include:
Treatment Considerations
When selecting a treatment regimen, it is essential to consider the following:
- Local prevalence of clarithromycin resistance 1, 2
- Previous use of macrolides 1
- Patient's medical history and current medications
- Potential for antibiotic-related adverse events, which can be reduced with probiotic supplementation 1
Treatment Regimens and Durations
The treatment regimens and durations may vary depending on the specific regimen and patient factors. For example:
- Triple therapy consisting of potassium-competitive acid blocker (P-CAB), amoxicillin, and clarithromycin for 1 week 3
- Proton pump inhibitors (PPI) or P-CAB combined with amoxicillin and metronidazole for 1 week 3
- Bismuth-based quadruple therapy for 14 days 2
Conclusion
The treatment of H. pylori infection requires a tailored approach, considering the local prevalence of clarithromycin resistance, previous use of macrolides, and patient factors. Quadruple therapies and clarithromycin-containing triple therapy are recommended as first-line treatment options, while levofloxacin-containing triple therapy and bismuth quadruple therapy are reserved for second-line treatment. Probiotic supplementation can help reduce antibiotic-related adverse events. Regular updates to treatment guidelines are necessary to combat the emerging problems of multidrug antimicrobial resistance in H. pylori strains 2.