Introduction to Gastrointestinal Diseases Vol. 2 by Jakub Fichna

Author:Jakub Fichna
Language: eng
Format: epub
Publisher: Springer International Publishing, Cham

8.6 Treatment

8.6.1 Standard Therapy vs. Sequential Therapy

There is no perfect and reliable drug regimen for the treatment of H. pylori so far. Typically, treatment lasts 10–14 days. First-line therapy consists of two of the three commonly used antibiotics such as amoxicillin, clarithromycin, and metronidazole, and PPIs. Dual therapies are not as effective as triple therapy and are not recommended. After failure, a quadruple therapy regimen is recommended with the addition of tetracycline or bismuth. When a second-line therapy fails, the management strategy includes an assessment of the sensitivity of H. pylori to amoxicillin, clarithromycin, metronidazole, and tetracycline. Of note, clarithromycin and metronidazole show the highest rates of resistance. The main factors associated with the resistance are geographic region, sex, ethnicity, and age of patients [22].

Sequential therapy allows to use more antibiotics, in successive stages which typically lasts 5–7 days. An example of such therapy is as follows: amoxicillin + PPIs for 5 days, and PPIs + clarithromycin + metronidazole for the next 5 days. In consequence, different mechanisms of antibacterial activity with a lower risk of side effects are expected [23]. Sequential therapy has been showed to be more effective than the standard treatment [24].

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