Abstract

RECENT GUIDELINES FOR H. PYLORI ERADICATION THERAPY

Michael G. Lee* and Yvonne Dawkins

ABSTRACT

Helicobacter pylori infection is one of the commonest chronic infections worldwide with an estimated 50% of the world’s population being infected. Approximately, 15 to 20% of infected individuals will develop clinical disease. Up to 95% of patients with duodenal ulcer disease and about 70% with gastric ulcer disease will be infected. Infection is also associated with gastric carcinoma and gastric MALT lymphoma. H. pylori is associated with dyspepsia and may be associated with unexplained iron deficiency anaemia and idiopathic thrombocytopenic purpura. All patients with a positive test for H. pylori should be offered eradication therapy. Over the past decade, resistance to some of the antibiotics used have increased worldwide and is a growing problem which will lead to treatment failure in 38 to 55%, if these are used. First line regimes are most important for successful eradication and should have an eradication rate of at least 90% as eradication becomes difficult with subsequent therapy. There have been updated guidelines by three expert groups over the past year and one recommendation for first line therapy is bismuth quadruple therapy consisting of, Bismuth / Tetracycline / Metronidazole/ PPI. The alternative first line therapy is the concomitant or clarithromycin quadruple regime consisting of, PPI/ Clarithromycin/ Amoxicillin / Metronidazole. For rescue therapy four regimes were recommended a) bismuth quadruple b) concomitant regime, c) levofloxacin triple therapy and d) rifabutin triple therapy, PPI/ Rifabutin/ Amoxicillin. Knowledge of resistance patterns for antibiotics used or the success of a particular regime in the local area is important for successful eradication therapy.

Keywords: H pylori, eradication, antibiotics, resistance.