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Ensuring the highest eradication rates in H. pylori: the case of non-bismuth quadruple concomitant therapy

  • Adrian G. McNicholl
    Affiliations
    Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
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  • A. Salvador Pena
    Affiliations
    Department of Microbiology & Infection Control, VU University Medical Center, Fransche Brug 22, Roelofarendsveen, The Netherlands
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  • Javier P. Gisbert
    Correspondence
    Corresponding author at: Hospital Universitario de La Princesa, Diego de León 62, 28006 Madrid, Spain. Tel.: +34 913093911; fax: +34 914022299.
    Affiliations
    Department of Gastroenterology, Hospital Universitario de La Princesa, Instituto de Investigación Sanitaria Princesa (IIS-IP), Madrid, Spain

    Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREHD), Madrid, Spain
    Search for articles by this author
      Management of Helicobacter pylori infection is still a problem in daily routine for many gastroenterologists, internists, and general practitioners [
      • Roberts S.E.
      • Morrison-Rees S.
      • Samuel D.G.
      • et al.
      Review article: the prevalence of Helicobacter pylori and the incidence of gastric cancer across Europe.
      ,
      • Malfertheiner P.
      • Megraud F.
      • O'Morain C.A.
      • et al.
      Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report.
      ]. These problems range from which patients should be tested or which diagnostic tests should be used, to which antibiotic regimen should be prescribed. The general recommendation for bacterial infections to always test antibacterial susceptibility may not be applicable or even efficient in the case of H. pylori management, mainly due to the requirement of an endoscopy [
      • Malfertheiner P.
      • Megraud F.
      • O'Morain C.A.
      • et al.
      Management of Helicobacter pylori infection–the Maastricht IV/Florence Consensus Report.
      ,
      • Gisbert J.P.
      • Calvet X.
      Helicobacter pylori “test-and-treat” strategy for management of dyspepsia: a comprehensive review.
      ]. A procedure that is expensive and uncomfortable, and even if performed, culture and antibiogram are not available in most centers. Moreover, the in vitro testing of the resistances does not accurately correlate with in vivo efficacy of the treatment. In this context, most of the real clinical practice is performed following “empirical” treatments based on literature (prevalence, efficacy, resistance), more than on the individual case. The correct use of the empirical approach for the treatment of H. pylori has two fundamental requisites: accurate estimation on the resistance rates of the target population and, even more importantly, evidence on the efficacy of each treatment according to resistance or in comparable contexts [
      • Papastergiou V.
      • Georgopoulos S.D.
      • Karatapanis S.
      Treatment of Helicobacter pylori infection: meeting the challenge of antimicrobial resistance.
      ,
      • Megraud F.
      Current recommendations for Helicobacter pylori therapies in a world of evolving resistance.
      ,
      • Graham D.Y.
      • Lee Y.C.
      • Wu M.S.
      Rational Helicobacter pylori therapy: evidence-based medicine rather than medicine-based evidence.
      ,
      • Molina-Infante J.
      • Shiotani A.
      Practical aspects in choosing a Helicobacter pylori therapy.
      ].

      Abbreviations:

      H. pylori (Helicobacter pylori), PPI (Proton pump inhibitor)

      Keywords

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