Strategy for treatment of Helicobacter pylori infection in adults. II. Practical policy in 2000

The approach to the patient with suspected H. pylori infection consists of an adequate indication to test for the presence of the infection, choice of an appropriate antimicrobial regimen, and education about its use and side effects, followed by post-therapy testing to confirm cure. We review the drugs and regimens for H. pylori eradication and present a strategy for treating the infection. The major factor in choosing an antibiotic regimen is the pattern of antibiotic resistance in the community. Triple therapy with a proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) and two antimicrobials is recommended as the first choice regimen. In regions where metronidazole and clarithromycin resistance are common, initial therapy with quadruple therapy consisting of bismuth, metronidazole, tetracycline, and a PPI is recommended. In general, higher doses and longer durations are associated with better outcomes. For this reason we recommend that the minimum duration of 10 days and we prefer 14 days. The actual choice of the antimicrobial combination will also be influenced by the drugs approved by the local regulatory bodies. Side effects, eradication failure and current as well as future designs of eradication therapies are also discussed.