Treatment of Helicobacter Pylori infection: optimization strategies in a high resistance era

Expert Opinion on Pharmacotherapy
Sotirios D GeorgopoulosStylianos Karatapanis

Abstract

Treatment of Helicobacter pylori (H. pylori) infection is paramount for the management of prevalent gastrointestinal disorders and in the prevention of gastric cancer. Due to increasing antimicrobial resistance, performance of standard triple therapies has now declined to unacceptably low levels. In this article: i) we critically revise optimization tools aiming to improve the outcome of standard treatments; ii) we provide updated evidence on the efficacy and rationale for the use of several non-bismuth quadruple regimens in clinical practice, recommended as preferred empirical therapies in areas of high clarithromycin resistance. Prolonged (14-day) treatment duration may boost the efficacy of standard triple therapy by approximately 5%. Use of a high-dose PPI and/or new-generation PPIs, rabeprazole and esomeprazole, might improve eradication rates, particularly in regions where the CYP2C19 rapid metabolizer phenotype is prevalent. Adjunctive probiotics may be considered to improve treatment tolerability, though more data are required to better define their role in H. pylori eradication. Among non-bismuth quadruple regimens, both concomitant and sequential therapies are appropriate options for high-resistance settings; however,...Continue Reading

References

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Mar 30, 2012·Clinical and Experimental Gastroenterology·Javier P Gisbert, Xavier Calvet
Apr 12, 2012·Gut·Peter MalfertheinerUNKNOWN European Helicobacter Study Group

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Citations

Oct 1, 2016·Scandinavian Journal of Gastroenterology·Floriana GiorgioAlfredo Di Leo
Nov 3, 2020·Expert Opinion on Pharmacotherapy·Sotirios Georgopoulos, Vasilios Papastergiou
Oct 2, 2021·Expert Opinion on Pharmacotherapy·Elias Xirouchakis, Sotirios D Georgopoulos

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