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World J Gastroenterol. May 14, 2014; 20(18): 5283-5293
Published online May 14, 2014. doi: 10.3748/wjg.v20.i18.5283
Treatment of Helicobacter pylori infection: Current status and future concepts
Jyh-Chin Yang, Chien-Wei Lu, Chun-Jung Lin
Jyh-Chin Yang, Department of Internal Medicine, Hospital and College of Medicine, National Taiwan University, Taipei 100, Taiwan
Chien-Wei Lu, Chun-Jung Lin, School of Pharmacy, National Taiwan University, Taipei 100, Taiwan
Author contributions: All the authors contributed equally to this manuscript.
Correspondence to: Chun-Jung Lin, PhD, School of Pharmacy, National Taiwan University, 1 Jen-Ai Road, Section 1, Taipei 100, Taiwan. clementumich@ntu.edu.tw
Telephone: +886-2-23123456 Fax: +886-2–23919098
Received: September 25, 2013
Revised: November 28, 2013
Accepted: January 19, 2014
Published online: May 14, 2014
Processing time: 230 Days and 20.8 Hours
Abstract

Helicobacter pylori (H. pylori) infection is highly associated with the occurrence of gastrointestinal diseases, including gastric inflammation, peptic ulcer, gastric cancer, and gastric mucosa-associated lymphoid-tissue lymphoma. Although alternative therapies, including phytomedicines and probiotics, have been used to improve eradication, current treatment still relies on a combination of antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, and levofloxacin, and antisecretory agents, such as proton pump inhibitors (PPIs). A standard triple therapy consisting of a PPI and two antibiotics (clarithromycin and amoxicillin/metronidazole) is widely used as the first-line regimen for treatment of infection, but the increased resistance of H. pylori to clarithromycin and metronidazole has significantly reduced the eradication rate using this therapy and bismuth-containing therapy or 10-d sequential therapy has therefore been proposed to replace standard triple therapy. Alternatively, levofloxacin-based triple therapy can be used as rescue therapy for H. pylori infection after failure of first-line therapy. The increase in resistance to antibiotics, including levofloxacin, may limit the applicability of such regimens. However, since resistance of H. pylori to amoxicillin is generally low, an optimized high dose dual therapy consisting of a PPI and amoxicillin can be an effective first-line or rescue therapy. In addition, the concomitant use of alternative medicine has the potential to provide additive or synergistic effects against H. pylori infection, though its efficacy needs to be verified in clinical studies.

Keywords: Helicobacter pylori; Antimicrobial agents; Proton pump inhibitor; Campylobacter pyloridis

Core tip: This article provides a review of therapeutic agents and therapies that have been used in the treatment of Helicobacter pylori infection. Factors that may affect treatment outcome are described and therapeutic strategy is recommended.