OPTIMIZED ERADICATION PROTOCOLS: RECOMMENDATIONS OF THE AMERICAN GASTROENTEROLOGIST BOARD, MASSTRIKHT v/FLORENTINE AND TORONTO CONSENSUSES

Abstract

The work objective is the analysis of approval documents concerning therapy of Helicobacter pylori (H. pylori) infection to formulate the most significant provisions for the practicing physician. The choice of the eradication therapy option must take into account the population antibiotic resistance and individual anamnesis of the antibiotics application. If resistance of H. pylori to clarithromycin in the population is lower than 15% or there are data of effectiveness of the standard triple therapy in the region, the optimized triple therapy must be used as first line therapy. If the resistance of H. pylori to clarithromycin in the population is higher than 15% or the anamnesis shows previous use by the patient of macrolides and if the situation by the antibiotic resistance in the region is unknown, bismuth quadrotherapy must be used as the first line eradication therapy. If triple therapy with clarithromycin was used the best second line treatment protocol is quadrotherapy with bismuth preparations. The optimum option of the third line therapy after the triple clarithromycin containing therapy and subsequent bismuth-containing therapy is the scheme with levofloxacin. The last line of therapy used after unsuccessfulness of 3-4 eradication schemes is protocol with rifabutin.

Keywords

• helicobacter pylori infection
• proton pump inhibitors
• clarithromycin
• metronidazole
• amoxicillin
• bismuth-containing quadrotherapy