Possibilities of Helicobacter pylori eradication based on current Maastricht VI/Florence Consensus recommendations in the world and in Ukraine

Abstract

Objective — to determine the role of adding tetracycline to bismuth‑containing quadrotherapy in the increasing of eradication effectiveness. Helicobacter pylori (H. pylori) is recognized as the main pathogen of humankind more than 40 years ago. Despite the treatment of H. pylori — positive individuals and the reduction of infection transmission in populations with improved socio‑economic standards of living, it remains the most widespread bacterial pathogen of humankind, infecting almost half of the Earth’s population. As a result, this pathogen continues to be a significant cause of morbidity and mortality worldwide. The issue of effective H. pylori eradication with its main goal to prevent of gastric cancer, remains relevant for many years. According to the current provisions of the latest Maastricht VI/Florence consensus, eradication is indicated for all infected patients, since H. pylori is recognized as a pathogen of the stomach, and H. pylori — associated gastritis is an infectious disease that causes a sequential cascade of carcinogenesis. Eradication therapy enables cancer prevention at any age in adults, but its effectiveness decreases with age. Therefore, timely and effective anti‑helicobacter therapy can prevent negative consequences in H. pylori — infected patients. The threshold for H. pylori eradication in most countries often does not reach the required level of 85%, including in Ukraine. Among the main factors, reducing the effectiveness of anti‑helicobacter therapy at the current stage is the growing resistance of H. pylori to antibacterial agents. In Ukraine, the level of clarithromycin resistance of H. pylori is not precisely determined, but, without a doubt, it is high. A rapid increase in resistance to fluoroquinolones is also noted. Because of this, one of the schemes for the first line of eradication therapy in the modern treatment algorithm in accordance with the Maastricht VI/Florence consensus recommends quadrotherapy with preparations of colloidal bismuth subcitrate, proton pump inhibitors, tetracycline and metronidazole lasting 10—14 days. In May 2024, Ukrainian pharmaceutical market will be supplied with new drug «Tetramax» containing 500 mg of tetracycline hydrochloride in one capsule. This is the only tetracycline in Ukraine with a convenient dosage, which can now be prescribed for effective H. pylori eradication. This approach is relevant and most effective in conditions of uncertain or high resistance to clarithromycin.