Helicobacter pylori eradication therapy

Hidekazu Suzuki, Toshihiro Nishizawa, Toshifumi Hibi

Research output: Contribution to journalReview article

79 Citations (Scopus)

Abstract

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcers and gastric cancer. H. pylori eradication has been shown to have a prophylactic effect against gastric cancer. According to several international guidelines, the first-line therapy for treating H. pylori infection consists of a proton pump inhibitor (PPI) or ranitidine bismuth citrate, with any two antibiotics among amoxicillin, clarithromycin and metronidazole, given for 7-14 days. However, even with these recommended regimens, H. pylori eradication failure is still seen in more than 20% of patients. The failure rate for first-line therapy may be higher in actual clinical practice, owing to the indiscriminate use of antibiotics. The recommended second-line therapy is a quadruple regimen composed of tetracycline, metronidazole, a bismuth salt and a PPI. The combination of PPI-amoxicillin-levofloxacin is a good option as second-line therapy. In the case of failure of second-line therapy, the patients should be evaluated using a case-by-case approach. European guidelines recommend culture before the selection of a third-line treatment based on the microbial antibiotic sensitivity. H. pylori isolates after two eradication failures are often resistant to both metronidazole and clarithromycin. The alternative candidates for third-line therapy are quinolones, tetracycline, rifabutin and furazolidone; high-dose PPI/amoxicillin therapy might also be promising.

Original languageEnglish
Pages (from-to)639-648
Number of pages10
JournalFuture Microbiology
Volume5
Issue number4
DOIs
Publication statusPublished - 2010 Apr 1

Keywords

  • Third-line therapy

ASJC Scopus subject areas

  • Microbiology
  • Microbiology (medical)

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  • Cite this

    Suzuki, H., Nishizawa, T., & Hibi, T. (2010). Helicobacter pylori eradication therapy. Future Microbiology, 5(4), 639-648. https://doi.org/10.2217/fmb.10.25