Treatment of Helicobacter pylori infection: Current status and future concepts
Journal
World Journal of Gastroenterology
Journal Volume
20
Journal Issue
18
Pages
5283-5293
Date Issued
2014
Author(s)
Abstract
Helicobacter pylori (H. pylori) infection is highly associated with the occurrence of gastrointestinal diseases, including gastric inflammation, peptic ulcer, gastric cancer, and gastric mucosa-associated lymphoid-tissue lymphoma. Although alternative therapies, including phytomedicines and probiotics, have been used to improve eradication, current treatment still relies on a combination of antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, and levofloxacin, and antisecretory agents, such as proton pump inhibitors (PPIs). A standard triple therapy consisting of a PPI and two antibiotics (clarithromycin and amoxicillin/metronidazole) is widely used as the first-line regimen for treatment of infection, but the increased resistance of H. pylori to clarithromycin and metronidazole has significantly reduced the eradication rate using this therapy and bismuth-containing therapy or 10-d sequential therapy has therefore been proposed to replace standard triple therapy. Alternatively, levofloxacin-based triple therapy can be used as rescue therapy for H. pylori infection after failure of first-line therapy. The increase in resistance to antibiotics, including levofloxacin, may limit the applicability of such regimens. However, since resistance of H. pylori to amoxicillin is generally low, an optimized high dose dual therapy consisting of a PPI and amoxicillin can be an effective first-line or rescue therapy. In addition, the concomitant use of alternative medicine has the potential to provide additive or synergistic effects against H. pylori infection, though its efficacy needs to be verified in clinical studies. ? 2014 Baishideng Publishing Group Co., Limited. All rights reserved.
SDGs
Other Subjects
amoxicillin; bismuth; catechin; clarithromycin; cytochrome P450 2C19; cytochrome P450 3A4; esomeprazole; interleukin 1beta; lansoprazole; levofloxacin; metronidazole; omeprazole; pantoprazole; probiotic agent; proton pump inhibitor; rabeprazole; rifabutin; roxithromycin; sialic acid; sulfonamide; tetracycline; tinidazole; antiinfective agent; proton pump inhibitor; antibiotic resistance; area under the curve; article; bacterial growth; Chinese medicine; disease eradication; drug efficacy; gene mutation; geographic distribution; Helicobacter infection; human; meta analysis (topic); minimum inhibitory concentration; practice guideline; prevalence; randomized controlled trial (topic); treatment duration; treatment outcome; alternative medicine; animal; drug administration; drug combination; drug effects; growth, development and aging; Helicobacter Infections; Helicobacter pylori; microbiology; pathogenicity; time; Animals; Anti-Bacterial Agents; Complementary Therapies; Drug Administration Schedule; Drug Resistance, Bacterial; Drug Therapy, Combination; Helicobacter Infections; Helicobacter pylori; Humans; Practice Guidelines as Topic; Probiotics; Proton Pump Inhibitors; Time Factors; Treatment Outcome
Type
journal article