Treatment of Helicobacter pylori infection: A clinical practice update.

BACKGROUND: Helicobacter pylori infection is still frequent in the community and all infected subjects should be offered an eradication therapy. Nowadays physicians have to face the challenge of antibiotic resistance in treating Helicobacter pylori-infected individuals.

AIM: This review provides an overview of current international guidelines and reports recent evidence from systematic reviews and clinical trials on the treatment of Helicobacter pylori infection and should help physicians to better treat their patients.

RESULTS: General rules to optimize the management of Helicobacter pylori infection include: (i) considering previous patient's exposure to antibiotics; (ii) using high dose of proton-pump inhibitors; and (iii) avoiding repeating the same regimen, if it has already failure. Bismuth quadruple therapy and concomitant therapy are the best first-line empirical treatments in areas with high clarithromycin resistance and in individuals with previous use of macrolides; otherwise, the 14-day clarithromycin-containing triple therapy is a valid regimen. The sequential therapy is no longer a suggested treatment by international guidelines.

CONCLUSIONS: Current international guidelines are consistent in defining treatment strategies for Helicobacter pylori infection. The use of national registries to monitor the efficacy and tolerability of different regimens in the real world of clinical practice is now needed.