Helicobacter pylori therapy: First-line options and rescue regimen

In the present paper, several points regarding Helicobacter pylori treatmen t are reviewed, with the following conclusions: (1) all different proton pu mp inhibitors (PPIs) are equivalent when prescribed with antibiotics; (2) r anitidine bismuth citrate is equal to or, in some cases with antibiotic res istance, more effective than PPI; (3) previous treatment with PPI does not seem to affect the rate of eradication obtained with PPI plus two antibioti cs; (4) just 1 week of PPI is enough to obtain duodenal ulcer healing, prov ided that H. pylori eradication is achieved; (5) the eradication rates seem to be higher in peptic ulcer than in nonulcer dyspepsia; (6) in areas wher e the prevalence of metronidazole resistance is high, triple therapy includ ing a PPI, clarithromycin, and amoxicillin is the best option, and (7) quad ruple therapy (PPI, bismuth, tetracycline, and metronidazole) is the recomm ended second-line therapy after PPI-clarithromycin-amoxicillin failure, alt hough replacing the PPI and the bismuth compound by ranitidine bismuth citr ate achieves also good results. Copyright (C) 2001 S. Karger AG, Basel.