PMID- 25187235
OWN - NLM
STAT- PubMed-not-MEDLINE
DCOM- 20141021
LR  - 20211021
IS  - 1092-8472 (Print)
IS  - 1092-8472 (Linking)
VI  - 12
IP  - 4
DP  - 2014 Dec
TI  - Current Paradigm and Future Directions for Treatment of Helicobacter pylori 
      Infection.
PG  - 373-84
LID - 10.1007/s11938-014-0027-6 [doi]
AB  - Once easily eradicated with triple or quadruple therapy, Helicobacter pylori 
      infection has become increasingly resistant to traditional first-line treatment 
      regimens because of emerging antibiotic resistance coupled with poor patient 
      compliance with completing the treatment course. Given decreasing H. pylori 
      eradication rates, there is considerable interest in evaluating new antibiotic 
      combinations and regimens, the addition of probiotics, and the development of new 
      paradigms such as concomitant, sequential, and hybrid medication dosing 
      strategies. Unfortunately, efforts thus far have not universally improved 
      treatment responses, as promising early results were often not extrapolated to 
      wider populations. This is probably due largely to regional variation in H. 
      pylori resistance patterns. Ideally, the standard of care should be dictated by 
      knowledge of local H. pylori antimicrobial resistance patterns and clinical 
      success rates rather than by empiric extrapolation from the literature. 
      Unfortunately, such knowledge is usually lacking in the USA. The expectation of a 
      first-line regimen is a minimum 80 % eradication rate in the local population. 
      Standard triple therapy with a proton pump inhibitor (PPI), amoxicillin, and 
      clarithromycin may still be effective in some areas; however, in populations with 
      high clarithromycin resistance, quadruple therapy with a metronidazole-based 
      regimen may be a better choice, and concomitant, sequential, or hybrid dosing 
      schedules should also be considered as possible first-line choices. Second- and 
      third-line treatment regimens consist of levofloxacin-based and rifabutin-based 
      therapies, respectively. Further work should be directed at establishing local 
      resistance patterns and eradication rates, developing H. pylori-specific 
      antibiotics, and starting culture-guided treatment programs. Ultimately, the 
      development of an H. pylori vaccine would bypass any issues with antibiotic 
      resistance by preventing the acquisition of infection altogether.
FAU - Ferreira, Jason
AU  - Ferreira J
AD  - Division of Gastroenterology, Department of Medicine, Warren Alpert Medical 
      School of Brown University, Rhode Island Hospital, 593 Eddy Street, APC 414, 
      Providence, RI, 02903, USA, jferreira2@lifespan.org.
FAU - Moss, Steven F
AU  - Moss SF
LA  - eng
PT  - Journal Article
PL  - United States
TA  - Curr Treat Options Gastroenterol
JT  - Current treatment options in gastroenterology
JID - 9815941
EDAT- 2014/09/05 06:00
MHDA- 2014/09/05 06:01
CRDT- 2014/09/05 06:00
PHST- 2014/09/05 06:00 [entrez]
PHST- 2014/09/05 06:00 [pubmed]
PHST- 2014/09/05 06:01 [medline]
AID - 10.1007/s11938-014-0027-6 [doi]
PST - ppublish
SO  - Curr Treat Options Gastroenterol. 2014 Dec;12(4):373-84. doi: 
      10.1007/s11938-014-0027-6.