PMID- 11982731
OWN - NLM
STAT- MEDLINE
DCOM- 20020725
LR  - 20190901
IS  - 0815-9319 (Print)
IS  - 0815-9319 (Linking)
VI  - 17
IP  - 4
DP  - 2002 Apr
TI  - Update on the management of Helicobacter pylori infection, including 
      drug-resistant organisms.
PG  - 482-7
AB  - Helicobacter pylori infection has many different clinical outcomes. Not all 
      infected persons need to be treated. Therefore, indications for treatment have to 
      be clear, and several consensus guidelines have been formulated to aid the 
      medical practitioner in this decision-making process. Triple therapy with a 
      proton pump inhibitor (PPI), in combination with amoxicillin and clarithromycin 
      is the established treatment of choice. For patients with penicillin 
      hypersensitivity, metronidazole can be substituted for amoxicillin. Bacterial 
      resistance to antibiotics is a major factor adversely affecting treatment 
      success. Resistance to metronidazole has been reported in up to 80%, and 
      resistance to clarithromycin in 2-10% of strains cultured. Resistance to either 
      one of the antibiotics has been reported to result in a drop in efficacy of up to 
      50%. Emergence of resistance to both metronidazole and clarithromycin following 
      failed therapy is a cause for concern; this underlines the need to use the best 
      available first-line therapy. To avoid the emergence of resistance to both key 
      antibiotics, the combination of metronidazole and clarithromycin should be 
      avoided where possible. For failed treatment, several strategies can be employed. 
      These include ensuring better compliance with repeat therapy, and maximizing the 
      efficacy of repeat treatment by increasing dosage and duration of treatment, as 
      well as altering the choice of drugs. Quadruple therapy incorporating a bismuth 
      compound with a PPI, tetracycline and metronidazole has been a popular choice as 
      a "rescue" therapy. Ranitidine bismuth citrate has been shown to be able to 
      overcome metronidazole and clarithromycin resistance; it may be a useful compound 
      drug to use in place of a PPI in "rescue" therapies. In the case of persistent 
      treatment failures, it is useful to consider repeating gastroscopy and obtaining 
      tissue for culture, and then prescribe antibiotics according to bacterial 
      susceptibility patterns. It is also important in refractory cases to review the 
      original indication for treatment and determine the importance of the indication.
CI  - Copyright 2002 Blackwell Publishing Asia Pty Ltd
FAU - Goh, K L
AU  - Goh KL
AD  - Department of Medicine, University of Malaya, 50603 Kuala Lumpur, Malaysia. 
      gohkl@ummc.edu.my
LA  - eng
PT  - Journal Article
PT  - Review
PL  - Australia
TA  - J Gastroenterol Hepatol
JT  - Journal of gastroenterology and hepatology
JID - 8607909
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Drug Resistance, Microbial
MH  - Helicobacter Infections/*drug therapy
MH  - Helicobacter pylori/*physiology
MH  - Humans
MH  - Retreatment
MH  - Treatment Failure
RF  - 41
EDAT- 2002/05/02 10:00
MHDA- 2002/07/26 10:01
CRDT- 2002/05/02 10:00
PHST- 2002/05/02 10:00 [pubmed]
PHST- 2002/07/26 10:01 [medline]
PHST- 2002/05/02 10:00 [entrez]
AID - 2735 [pii]
AID - 10.1046/j.1440-1746.2002.02735.x [doi]
PST - ppublish
SO  - J Gastroenterol Hepatol. 2002 Apr;17(4):482-7. doi: 
      10.1046/j.1440-1746.2002.02735.x.