Treatment of Helicobacter pylori

ABSTRACT

The seroprevalence of Helicobacter pylori (H. pylori) in Korea was found to be decreased. However eradication rate of 1st line therapy has become lower and antimicrobial resistance has increased, recently. Therefore we must also be prepared to face treatment failure and in designing a treatment strategy we should not focus on the results of 1st line therapy alone, but also on the rescue therapy. Some studies have demonstrated that levofloxacine-based triple regimen shows favourable results in 2nd or 3rd line therapy. However, it has shown that resistance to quinolones is easily acquired, and in Korea with a high consumption of these drugs, the resistance rate is increasing and is already relatively high. Therefore it should be reserved for final rescue treatment. Another potential regimen for final rescue therapy is rifabutin-based regimen which is known to be effective for H. pylori strains resistant to clarithromycin or metronidazole. Several concerns still remain, however, regarding rifabutin treatment. Firstly it is very expensive. Secondly myelotoxicity such as leukopenia and thrombocytopenia have been reported in some patients treated with rifabutin. Finally because of multiresistant strains of Mycobacterium tuberculosis increasing in numbers, indications for these drugs should be chosen very carefully to avoid further acceleration of development of resistance. Therefore refabutin should be considered only as the last option. It is difficult to choose proper treatment in Korea after failure of 2nd line treatment, because only a few study about 3rd line rescue therapy have been reported. Therefore we need more well designed randomized controlled studies.