Title:Choosing Optimal Firstline Helicobacter pylori Therapy: a View from a Region with High Rates of Antibiotic Resistance
Volume: 20
Issue: 28
Author(s): Alexander A. Nijevitch, Bulat Idrisov, Elsa N. Akhmadeeva and David Y. Graham
Affiliation:
Keywords:
Helicobacter pylori, review, first-line eradication, Russia, concomitant therapy, bismuth quadruple therapy, furazolidone quadruple
therapy.
Abstract: Helicobacter pylori is a gram-negative, microaerophilic spiral bacillus that is associated with life-threatening diseases such as
gastric cancer, gastric MALT lymphoma, and peptic ulcer disease. The definition of an effective therapy is one that achieves at least a
90% eradication rate on a per-protocol basis with the first attempt. Eradication rates of H. pylori have declined to unacceptable levels
worldwide, mostly due to antibiotic resistance and standard triple therapy gradually has lost its efficacy in most counties. However, bismuth
quadruple therapy, when prescribed properly, has maintained its effectiveness. Alternative first-line regimens such as sequential
and concomitant therapy were developed to substitute for standard triple therapy and were highly effective in the countries where they
were developed, but proved susceptible to failure in regions with high rates of antibiotic resistance. Antibiotic resistance rates in Russia
are high, however there is lack of data regarding comparative efficacy of first-line eradication options. The authors of this review extrapolate
the knowledge of H. pylori first-line eradication options in Russia based on data from other countries, as well as from domestic
studies. The available data support use of 14-day regimens with concomitant therapy, bismuth quadruple therapy, or furazolidone quadruple
therapy for empiric use in adults. In addition, 14-day levofloxacin-containing therapies could be used if resistance is relatively low
or lacking as triple therapy or possibly as a 5-day concomitant levofloxacin therapy.
