Pharmacokinetic considerations in the eradication of Helicobacter pylori

As Helicobacter pylori plays an important role in the aetiopathogenesis of peptic ulcer, therapeutic strategies aimed at maintaining long term remissi on have shifted from the control of intragastric pH to targeting H. pylori. According to recent international guidelines the clinical goals - rapid ni cer healing and prevention of relapse - can be best accomplished by combina tion therapy consisting of an antisecretory drug (proton pump inhibitor or ranitidine) and 2 antimicrobial agents (preferable amoxicillin, clarithromy cin or metronidazole). When applying such multidrug regimens, possible synergy between the agents suggests that pharmacokinetic considerations might help to improve H, pylor i eradication rates, which should be above 85 to 90% on an intention-to-tre at basis. The present review summarises the pharmacokinetic properties and interaction potential of all drugs presently used in the various H. pylori eradication regimens, with emphasis on particular patient populations such as the elderly and those with renal impairment. The drugs considered are om eprazole. lansoprazole, pontoprazole, rabeprazole. ranitidine and ranitidin e bismutrex. bismuth salts. amoxicillin. clarithromycin, azithromycin, roxi thromycin, metronidazole, tinidazole and tetracycline. When addressing the clinically important questions of the efficacy, safety and cost of the recommended regimens. the impact of drug disposition on H. pylori eradication should not be neglected.