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Treatment for H. pylori Infection: New Challenges With Antimicrobial Resistance

Vakil, Nimish MD, FACP, FACG, AGAF, FASGE*; Vaira, Dino MD

Journal of Clinical Gastroenterology: May/June 2013 - Volume 47 - Issue 5 - p 383–388
doi: 10.1097/MCG.0b013e318277577b

The treatment of Helicobacter pylori infection is in a state of flux as traditional therapies fail and new therapies do not achieve the 90% eradication rates desired by clinicians. Triple therapy, which has been the mainstay of treatment in many countries over the last decade, now has suboptimal results in many parts of the world. A number of new treatments have been described with variable success in different parts of the world. In this article, the fundamentals of treatment for H. pylori treatment are reviewed and new treatment algorithms are proposed for regions of the world where triple therapy is failing. Sequential therapy and quadruple therapy (either bismuth-based or non–bismuth-based) are the best current options to replace initial treatment with triple therapy. When initial treatment fails, salvage treatments using rifabutin and levofloxacin are the best options. With knowledge of local resistance patterns and with meticulous confirmation of eradication with retreatment, most H. pylori infections can be successfully eradicated.

*University of Wisconsin School of Medicine and Public Health, Madison, WI

Department of Clinical Medicine, S. Orsola Hospital, University of Bologna, Bologna, Italy

N.V.: Consultant at Astra-Zeneca, Takeda, Axcan, Otsuka. The remaining author declares that he has nothing to disclose.

Reprints: Nimish Vakil, MD, FACP, FACG, AGAF, FASGE, Aurora Summit Hospital, 56500 Aurora Drive, Summit WI 53066 (e-mail:

© 2013 by Lippincott Williams & Wilkins