Practical advice on eradicating Helicobacter pylori infection

Peptic ulcer disease associated with H-pylori infection is curable. The imp ortant factors in selecting therapy are efficacy of eradication, prevention of resistantce, avoidance or minimization of adverse effects, patient comp liance, and cost. The most effective regimens include a bismuth preparation or antisecretory drug (proton pump inhibitor or H-2 receptor antagonist) plus two antibiotic s administered for 14 days. Dual-drug therapies are not recommended. Triple -drug regimens are more likely to eradicate H-pylori and less likely to gen erate resistant strains among survinging organisms. In general, cure of the infeciton should be confirmed 4 weeks after completion of the treatment. A ntibiotic resistance is an important consideration in choosing therapy, and patients should be taught the importance of compliance. When treatment fai ls, antibiotic combinations shoudl not be repeated. Consideraions for anti- H-pylori treatment in a managed care environment mirror those for good medi cal practice in general, with special attention to stringent cost-control o r outcomes-driven measures.