Third-line rescue therapy for Helicobacter pylori infection

• Published in: World journal of gastroenterology : WJG Vol. 12; no. 15; pp. 2313 - 2319
• Main Author: Cianci, Rossella
• Format: Journal Article
• Language: English
• Published: United States Department of Internal Medicine, Endoscopy Unit, Catholic University of Sacred Heart, Rome, Italy 21.04.2006; Baishideng Publishing Group Co., Limited
• Subjects: Anti-Bacterial Agents - therapeutic use; Doxycycline - therapeutic use; Furazolidone - therapeutic use; Helicobacter Infections - drug therapy; Helicobacter pylori; Humans; Ofloxacin - therapeutic use; Rifabutin - therapeutic use; Rifampin - therapeutic use; Treatment Failure; Rifabutin; Furazolidone; Levofioxacin; Helicobacter pylori; Doxycycline; Third-line rescue therapy; Antimicrobial resistance
• ISSN: 1007-9327; 2219-2840
• DOI: 10.3748/wjg.v12.i15.2313

H pylori gastric infection is one of the most prevalent infectious diseases worldwide. The discovery that most upper gastrointestinal diseases are related to H pylori infection and therefore can be treated with antibiotics is an important medical advance. Currently, a first-line triple therapy based on proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) plus two antibiotics (clarithromycin and amoxicillin or nitroimidazole) is recommended by all consensus conferences and guidelines. Even with the correct use of this drug combination, infection can not be eradicated in up to 23% of patients. Therefore, several second line therapies have been recommended. A 7 d quadruple therapy based on PPI, bismuth, tetracycline and metronidazole is the more frequently accepted. However, with second-line therapy, bacterial eradication may fail in up to 40% of cases. When H pylori eradication is strictly indicated the choice of further treatment is controversial. Currently, a standard third-line therapy is lacking and various protocols have been proposed. Even after two consecutive failures, the most recent literature data have demonstrated that H pylori eradication can be achieved in almost all patients, even when antibiotic susceptibility is not tested. Different possibilities of empirical treatment exist and the available third-line strategies are herein reviewed.