Rescue Therapy for Helicobacter pylori Infection 2012.

Javier P Gisbert

doi:10.1155/2012/974594

Abstract

Helicobacter pylori infection is the main cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After 30 years of experience in H. pylori treatment, however, the ideal regimen to treat this infection has still to be found. Nowadays, apart from having to know well first-line eradication regimens, we must also be prepared to face treatment failures. In designing a treatment strategy, we should not only focus on the results of primary therapy alone but also on the final—overall—eradication rate. The choice of a “rescue” treatment depends on which treatment is used initially. If a first-line clarithromycin-based regimen was used, a second-line metronidazole-based treatment (quadruple therapy) may be used afterwards, and then a levofloxacin-based combination would be a third-line “rescue” option. Alternatively, it has recently been suggested that levofloxacin-based “rescue” therapy constitutes an encouraging 2nd-line strategy, representing an alternative to quadruple therapy in patients with previous PPI-clarithromycin-amoxicillin failure, with the advantage of efficacy, simplicity and safety. In this case, quadruple regimen may be reserved as a 3rd-line “rescue” option. Even after two consecutive failures, several studies have demonstrated that H. pylori eradication can finally be achieved in almost all patients if several “rescue” therapies are consecutively given.

Highlights

Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease, and gastric cancer
Antibiotic resistance to clarithromycin has been identified as one of the major factors affecting our ability to cure H. pylori infection, and the rate of resistance to this antibiotic seems to be increasing in many geographical areas [16,17,18,19]
After failure of a combination of a pump inhibitors (PPIs)-based triple regimen, the use of the quadruple therapy has been generally recommended as the optimal second-line therapy based on the relatively good results reported by several authors

Summary

Introduction

Helicobacter pylori infection is the main known cause of gastritis, gastroduodenal ulcer disease, and gastric cancer. After failure of a combination of a PPI-based triple regimen, the use of the quadruple therapy has been generally recommended as the optimal second-line therapy based on the relatively good results reported by several authors This quadruple regimen requires the administration of 4 drugs with a complex scheme (bismuth and tetracycline usually prescribed every 6 hours, and metronidazole every 8 hours) and is associated with a relatively high incidence of adverse effects [20]; this drawback may be overcome, thanks to a novel single capsule containing bismuth, metronidazole, and tetracycline that has recently become available [66, 67].

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