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World J Gastroenterol. Sep 21, 2011; 17(35): 3971-3975
Published online Sep 21, 2011. doi: 10.3748/wjg.v17.i35.3971
A new look at anti-Helicobacter pylori therapy
Seng-Kee Chuah, Feng-Woei Tsay, Ping-I Hsu, Deng-Chyang Wu
Seng-Kee Chuah, Division of Gastroenterology, Kaohsiung Chang Gung Memorial Hospital, College of Medicine, Chang Gung University, 833 Kaohsiung, Taiwan
Feng-Woei Tsay, Ping-I Hsu, Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Veterans General Hospital, National Yang-Ming University, 813 Kaohsiung, Taiwan
Ping-I Hsu, Department of General Medicine, School of Medicine, College of Medicine, Taipei Medical University, 110 Taipei, Taiwan
Deng-Chyang Wu, Department of Internal Medicine, Kaohsiung Medical University Hospital, 807 Kaohsiung, Taiwan
Author contributions: Chuah SK wrote the paper, Tsay FW and Wu DC revised the paper, Hsu PI drafted and approved the final version.
Correspondence to: Dr. Ping-I Hsu, Division of Gastroenterology, Department of Internal Medicine, Kaoshiung Veterans General Hospital, 386 Ta Chung 1st Road, 813 Kaohsiung, Taiwan.
Telephone: +886-7-3462074 Fax: +886-7-3468237
Received: May 25, 2011
Revised: August 11, 2011
Accepted: August 15, 2011
Published online: September 21, 2011

With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e., 80% or less) in most countries. Therefore, several treatment regimens have emerged to cure Helicobacter pylori (H. pylori) infection. Novel first-line anti-H. pylori therapies in 2011 include sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy. After the failure of standard triple therapy, a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI), bismuth, tetracycline and metronidazole can be employed as rescue treatment. Recently, triple therapy combining a PPI, levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy. This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects. The best second-line therapy for patients who fail to eradicate H. pylori with first-line therapies containing clarithromycin, amoxicillin and metronidazole is unclear. However, a levofloxacin-based triple therapy is an accepted rescue treatment. Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test. Nonetheless, an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H. pylori infection if antimicrobial sensitivity data are unavailable.

Keywords: Bismuth-containing quadruple therapy, Concomitant quadruple therapy, Hybrid (dual-concomitant) therapy, Rescue anti- Helicobacter pylori treatment, Sequential therapy