Attempts to enhance the eradication rate of Helicobacter pylori infection

Abstract

Increasing rates of antimicrobial resistance to clarithromycin and metronidazole present challenges in maintaining optimal eradication rates. Knowledge of local antibiotic resistance and consumption pattern is important in selecting a reliable regimen. In addition, adverse effect profiles of therapeutic regimens are important and must be addressed to enhance compliance rates. Various methods of enhancing the eradication rates of Helicobacter pylori (H. pylori) have been investigated, including changing combinations or durations of established drugs, adding adjuvant drugs, or development of new molecules or agents. Bismuth-containing quadruple, sequential, concomitant, and levofloxacin-based triple therapies are replacing the long-standing standard of the triple regimen. Despite the encouraging results of these regimens, individualized approaches like treatment after antibiotics resistance test or CYP2C19 genotyping would be the mainstream of future therapy. Because scientific, economic, and technical problems make these advance therapies unfit for widespread use, future development for H. pylori therapy should be directed to overcome individualized antibiotic resistance. Although various novel regimens and additive agents have indicated favorable outcomes, more studies or validations are needed to become a mainstream H. pylori therapy.

Keywords: Helicobacter pylori, Antimicrobial drug resistance, Clarithromycin, Metronidazole, Microbial sensitivity tests

Core tip: There is no uniform and definite therapeutic regimen for the Helicobacter pylori (H. pylori) eradication currently. Increasing rates of antimicrobial resistance present challenges in maintaining optimal eradication rates. Knowledge of local antibiotic resistance and antibiotic consumption pattern is important in selecting a reliable regimen. In addition, adverse effect profiles of therapeutic regimens are important to enhance compliance rates. Bismuth-containing quadruple, sequential, concomitant, and levofloxacin-based triple therapies are replacing the long-standing standard of the triple regimen. Although various novel regimens and additive agents have indicated favorable outcomes, more studies or validations are needed to become a mainstream H. pylori therapy.