Helicobacter pylori eradication: therapy other than with bismuth or proton-pump inhibitors

Antibiotics alone do not achieve Helicobacter (H. pylori) eradication perhaps because of reduced activity in an acid environment. Some reports suggest that ranitidine combined with amoxicillin and metronidazole is highly successful in eradicating H. pylori, but other have found less success with H2-antagonists. Studies have shown that sucralfate is equally as effective as omeprazole when combined with clarithromycin and metronidazole in achieving H. pylori eradication. Similarly, sucralfate triple therapy (substituted for bismuth) may provide cost efficient treatment. Whilst immunization to protect against Helicobacter infection seems attractive, a large amount of animal work needs to be done before the necessary tedious human trials. Future trends in H. pylori eradication may involve 1-week therapy combining proton-pump inhibitors, bismuth or sucralfate and two antibiotics. It is hoped that such regimens will be simple, effective, relatively inexpensive and free of side effects.