Campylobacter pylori--therapy review

Although Campylobacter pylori is sensitive to many antibiotics in vitro, few are effective in vivo. Furthermore, treatment regimens which successfully clear the organism in vivo are associated with high recurrence rates when assessed one month following treatment. On the other hand, 85% of those individuals who are C. pylori negative 1 month after the cessation of therapy remain negative at 12 months and the infection can be considered to be eradicated. Treatment with certain bismuth salts appears to be the most useful monotherapy, eradicating the organism in approximately 19% whilst dual therapy with bismuth plus ampicillin or tinidazole is more effective, eradicating infection in 32% and 78% respectively. Preliminary data suggest that triple therapy with bismuth, amoxicillin and metronidazole, or bismuth, tetracycline and metronidazole eradicates the infection in over 90%.