[Clinico-pharmacologic considerations in Helicobacter pylori eradication therapy]

Problems and pitfalls of treatment regimens for eradication of Helicobacter pylori (Hp) are discussed from a clinical, pharmacological and microbiological point of view. Problems concerning the physician who treats the patient consists mainly in inappropriate indication and suboptimal knowledge of drugs, doses and duration of therapy against Hp. For successful triple therapy with complicated dosage protocols cooperation with and compliance by the patient is stressed. Physicochemical, pharmacological and pharmacokinetic properties of bismuth salts and antibiotics as well as physiological aspects of pH and motility in the stomach must be considered in order to achieve optimal antibactericidal concentrations in the special micro milieu of Hp in the mucus/on the mucosa of the stomach. In addition, present pretreatment resistance of Hp against antibiotics and possible acquired resistance during antibiotic treatment are important aspects. Successful eradication of Hp mainly depends on the physician's clinical and pharmacological knowledge of bismuth salts and antibiotics, on considerations of microbiological aspects of Hp, on good doctor-patient-relationship and compliance by the patient.