PMID- 20525969
OWN - NLM
STAT- MEDLINE
DCOM- 20101122
LR  - 20220408
IS  - 1468-3288 (Electronic)
IS  - 0017-5749 (Linking)
VI  - 59
IP  - 8
DP  - 2010 Aug
TI  - Helicobacter pylori treatment in the era of increasing antibiotic resistance.
PG  - 1143-53
LID - 10.1136/gut.2009.192757 [doi]
AB  - With few exceptions, the most commonly recommended triple Helicobacter pylori 
      regimen (proton pump inhibitor (PPI), amoxicillin and clarithromycin) now 
      provides unacceptably low treatment success. A review of worldwide results 
      suggests that successful eradication using a triple regimen is not consistently 
      observed in any population. Clinicians should use 'only use what works locally' 
      and ignore consensus statements and society guidelines if they are not consistent 
      with local results. Clinical trials should be result based, with the goal of 
      identifying regimens with >90-95% success. New treatments should be only be 
      compared with the currently locally effective treatment (>90%) or a historical 
      untreated control (which has been shown to reliably yield 0% eradication); trials 
      using placebos or treatments known to be inferior are with rare exceptions 
      unethical. If a highly effective regimen is not available locally, we recommend 
      trying a 14 day concomitant quadruple treatment regimen containing a PPI, 
      amoxicillin, clarithromycin and a nitroimidazole; 10 day sequential treatment 
      (PPI plus amoxicillin for 5 days followed by a PPI, clarithromycin and a 
      nitroimidazole for 5 days); or 14 day bismuth-containing quadruple treatments. 
      Treatments needing further evaluation include those containing furazolidone or 
      nitazoxanide, hybrids of sequential-concomitant therapies and amoxicillin-PPI 
      dual therapy with PPI doses such that they maintain intragastric pH >6.
FAU - Graham, David Y
AU  - Graham DY
AD  - Department of Medicine, Michael E DeBakey Veterans Affairs Medical Center and 
      Baylor College of Medicine, Houston, Texas 77030, USA. dgraham@bcm.tmc.edu
FAU - Fischbach, Lori
AU  - Fischbach L
LA  - eng
GR  - DK56338/DK/NIDDK NIH HHS/United States
GR  - R01 CA116845/CA/NCI NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, U.S. Gov't, Non-P.H.S.
PT  - Review
DEP - 20100604
PL  - England
TA  - Gut
JT  - Gut
JID - 2985108R
RN  - 0 (Anti-Bacterial Agents)
SB  - IM
MH  - Adult
MH  - Anti-Bacterial Agents/*therapeutic use
MH  - Drug Resistance, Bacterial
MH  - Drug Therapy, Combination
MH  - Helicobacter Infections/*drug therapy
MH  - Helicobacter pylori/*drug effects
MH  - Humans
MH  - Practice Guidelines as Topic
MH  - Treatment Failure
MH  - Treatment Outcome
EDAT- 2010/06/08 06:00
MHDA- 2010/12/14 06:00
CRDT- 2010/06/08 06:00
PHST- 2010/06/08 06:00 [entrez]
PHST- 2010/06/08 06:00 [pubmed]
PHST- 2010/12/14 06:00 [medline]
AID - gut.2009.192757 [pii]
AID - 10.1136/gut.2009.192757 [doi]
PST - ppublish
SO  - Gut. 2010 Aug;59(8):1143-53. doi: 10.1136/gut.2009.192757. Epub 2010 Jun 4.