Treatment of helicobacter pylori infection- a review
Abstract
The realization that Helicobacter pylori infection is one of the most important etiological factors for peptic ulcer has had an enormous impact on approach to the management of ulcer disease. Today, there is no longer anyserious debate about the value or appropriateness of treatment of H. pylori in patients with peptic ulcer or low-grade mucosa associated lymphoid tissue (MALT) lymphoma. Many antimicrobial agents have been studied for their efficacy in eradicating H. pylori infection either as a single agent or as a combination therapy. Single drug regimens are not advocated due to the potential for the development of antibiotic resistance especially to macrolides and nitroimidazoles, which are the key antimicrobial agents in the multi-drug regimens for H. pylori. Dual treatments combining a proton pump inhibitor (PPI) with either clarithromycin or amoxicillin were popular a few years ago as they were easy to explain and well tolerated. They have now been abandoned because of unacceptly low eradication rates. Bismuth based triple therapy consisting of colloidal bismuth subcitrate, tetracycline and metronidazole for two weeks is cheap, well investigated and reaches high cure rates in metronidazole sensitive strains. Even though bismuth based triple therapies have high and acceptable eradication rates in areas with low nitroimidazole resistance, in developing countries the response to this therapy is low as 80-90% of H. pylori strains are resistant to metronidazole. Triple…
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