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Arch Hellen Med, 20(6), November-December 2003, 654-661


Helicobacter pylori first step eradication therapy. Is it really so simple?
A critical review

12nd Department of Gastroenterology, .Evagelismos. Hospital, Athens
2Department of Gastroenterology, Athens Medical Group, P. Faliron Hospital, Athens, Greece

Helicobacter pylori (Hp) has been incriminated in many peptic lesions, over recent years. The eradication of Hp is therefore crucial and effective treatment is considered that with a high eradication yield and a low resistance rate outcome. Combined first step therapies with an antisecretory component and two antibiotics are currently employed to meet the above criteria. The antisecretory component should be a proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) prescribed twice daily. Among the antibiotics clarithromycin (CLA) forms the basis of current treatment schemes, usually in combination with amoxycillin (AMO) or metronidazole (MET). The duration of treatment is between seven and ten days. Patient compliance or Hp strains resistant to antibiotics influence the Hp eradication yield. Primary or secondary resistance mainly to MET and less frequently to CLA are important causes of treatment failure. In areas with high MET resistance, physicians can overcome the problem through prescribing either the RBC based regimen (RBC+CLA+MET) or the combination of PPI, CLA and AMO or finally the bismuth based quadruple therapy.

Key words: Eradication therapy, Helicobacter pylori, Resistance, Triple-therapy schemes.

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