Eradication of Helicobacter pylori: why does it fail?

Currently, the first therapeutic attempt to eradicate Helicobacter pylori f ails in one case out of six in intention to treat analysis. The main causes of failure are bad compliance, partly because of side effects that are sev ere in 1 to 4% of cases, absence of local validation of the treatment schem e, since some differences do exist between regions and countries, primary a nd secondary resistance of the strain (stable for Imidazole-derivates, but increasing for Macrolides), and, to a lesser extent, smoking and pre-treatm ent with proton pump inhibitors. Moreover, in routine medicine, inappropria te treatment cocktails are still prescribed, even by gastroenterologists. O bviously, there is a need for careful medical education and information bot h as far as concerns doctors and patients, for well-designed prescription, based on local experience and the precise previous history of every patient , as well as for continuous monitoring of the bacterial resistance to antib iotics. Culture of the strain is recommended after eradication failure with the classic one-week triple therapy, but if reliable culture and resistanc e testing are not available, the quadruple therapy as a second-line treatme nt is, so far, the best choice.