AUTHOR=Hu Yi , Zhu Yin , Lu Nong-Hua 

TITLE=Novel and Effective Therapeutic Regimens for Helicobacter pylori in an Era of Increasing Antibiotic Resistance

JOURNAL=Frontiers in Cellular and Infection Microbiology

VOLUME=7

YEAR=2017

URL=https://www.frontiersin.org/journals/cellular-and-infection-microbiology/articles/10.3389/fcimb.2017.00168

DOI=10.3389/fcimb.2017.00168

ISSN=2235-2988

ABSTRACT=<p><italic>Helicobacter pylori</italic> (<italic>H. pylori</italic>) is a common gastrointestinal bacterial strain closely associated with the incidence of chronic gastritis, peptic ulcers, gastric mucosa-associated lymphoid tissue lymphoma, and gastric cancer. A current research and clinical challenge is the increased rate of antibiotic resistance in <italic>H. pylori</italic>, which has led to a decreased <italic>H. pylori</italic> eradication rate. In this article, we review recent <italic>H. pylori</italic> infection and reinfection rates and <italic>H. pylori</italic> resistance to antibiotics, and we discuss the pertinent treatments. A PubMed literature search was performed using the following keywords: <italic>Helicobacter pylori</italic>, infection, reinfection, antibiotic resistance, bismuth, proton pump inhibitors, vonoprazan, susceptibility, quintuple therapy, dual therapy, and probiotic. The prevalence of <italic>H. pylori</italic> has remained high in some areas despite the decreasing trend of <italic>H. pylori</italic> prevalence observed over time. Additionally, the <italic>H. pylori</italic> reinfection rate has varied in different countries due to socioeconomic and hygienic conditions. <italic>Helicobacter pylori</italic> monoresistance to clarithromycin, metronidazole or levofloxacin was common in most countries. However, the prevalence of amoxicillin and tetracycline resistance has remained low. Because <italic>H. pylori</italic> infection and reinfection present serious challenges and because <italic>H. pylori</italic> resistance to clarithromycin, metronidazole or levofloxacin remains high in most countries, the selection of an efficient regimen to eradicate <italic>H. pylori</italic> is critical. Currently, bismuth-containing quadruple therapies still achieve high eradication rates. Moreover, susceptibility-based therapies are alternatives because they may avoid the use of unnecessary antibiotics. Novel regimens, e.g., vonoprazan-containing triple therapies, quintuple therapies, high-dose dual therapies, and standard triple therapies with probiotics, require further studies concerning their efficiency and safety for treating <italic>H. pylori</italic>.</p>