[Therapy of Campylobacter pylori infection]

A simple and efficient therapy eradicating C. pylori with high reliability from gastroduodenal mucosae is presently unknown. In regard to such a "puristic" approach, antibiotics given as monotherapy are presently as ineffective as bismuth salts, which may temporarily reduce the bacterial density, but yield a low complete bacterial eradication rate of not more than 10% to 30% of all patients. Pilot studies are being performed in many centers to identify more efficacious drugs or combinations. Alternative modalities, such as manipulation of mucus, active vaccination, or clearing of bacterial sources in the environment, presently represent nothing but hypothetical models. Bismuth salts might play an important future role in a more "pragmatic" approach, which investigates any potential clinical benefit derived from a mere suppression of bacterial growth, possibly resulting in a temporary restoration of the mucosal integrity. However, this approach will probably fail to modify the long-term natural history of C. pylori-associated chronic gastritis and its sequelae.