CLINICAL AND PHARMACOLOGICAL CONSIDERATIO NS ON TREATMENT REGIMENS FOR ERADICATION OF HELICOBACTER-PYLORI

Problems and pitfalls of treatment regimens for eradication of Helicob acter pylori (Hp) are discussed from a clinical, pharmacological and m icrobiological point of view. Problems concerning the physician who tr eats the patient consists mainly in inappropriate indication and subop timal knowledge of drugs, doses and duration of therapy against Hp. Fo r successfull triple therapy with complicated dosage protocols coopera tion with and compliance by the patient is stressed. Physicochemical, pharmacological and pharmacokinetic properties of bismuth salts and an tibiotics as well as physiological aspects of pH and motility in the s tomach must be considered in order to achieve optimal antibactericidal concentrations in the special micro milieu of Hp in the mucus / on th e mucosa of the stomach. In addition, present pretreatment resistence of Hp against antibiotiics and possible acquired resistence during ant ibiotic treatment are important aspects. Successfull eradication of Hp mainly depends on the physician's clinical and pharmacological knowle dge of bismuth salts and antibiotics, on considerations of microbiolog ical aspects of Hp, on good doctor-patient-relationship and compliance by the patient.