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What is the best salvage therapy for patients with Helicobacter pylori infection?

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 608–609 (2008)Cite this article

The eradication of Helicobacter pylori (H. pylori) infection is still a challenge for clinicians. As with other chronic infectious diseases, eradication of H. pylori infection is achieved by the administration of several antibiotics simultaneously and, on occasion, by repeated courses of different antibiotic combinations. After two courses of treatment, generally represented by PPI-based triple and quadruple therapy regimens, about 4–6% of patients remain infected.1

Eradication therapies fail mainly because of H. pylori resistance to drugs and inadequate patient adherence to therapy. Clarithromycin resistance is the strongest predictor of treatment failure; therefore, it has been recommended that when patients have previously received a macrolide, clarithromycin-based regimens should not be considered for H. pylori eradication.2 By contrast, metronidazole resistance does not significantly influence the outcome of a nitroimidazole-containing therapeutic regimen.3 Adherence of patients to the prescribed treatment regimen also plays a pivotal part in H. pylori eradication and should be taken into account when a multidrug regimen is proposed because the level of complexity involved in this type treatment strategy leads to reduced compliance. Several other factors, such as baseline condition (i.e. peptic ulcer disease or non-ulcer dyspepsia), might potentially influence treatment outcome; however, the limited available data on this topic do not enable any definitive conclusions to be drawn.

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Authors and Affiliations

  1. RM Zagari and F Bazzoli are all Doctors in the Department of Internal Medicine and Gastroenterology at the University of Bologna, L Fuccio, Bologna, Italy.,

    Lorenzo Fuccio, Rocco Maurizio Zagari & Franco Bazzoli

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  1. Lorenzo Fuccio
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  2. Rocco Maurizio Zagari
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  3. Franco Bazzoli
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Correspondence to Franco Bazzoli.

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The authors declare no competing financial interests.

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Fuccio, L., Zagari, R. & Bazzoli, F. What is the best salvage therapy for patients with Helicobacter pylori infection?. Nat Rev Gastroenterol Hepatol 5, 608–609 (2008). https://doi.org/10.1038/ncpgasthep1256

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