- Helicobacter pylori infects the stomach of humans. It is a common cause of peptic ulcers and gastric cancer.
- The treatment of Helicobacter pylori infection aims to eradicate the bacteria, relieve symptoms, and prevent complications such as ulcers and gastric cancer.
- Standard treatment typically involves a combination of antibiotics and acid suppression therapy to enhance effectiveness.
- First-Line Therapy
- The most commonly used first-line treatment is triple therapy, which includes a proton pump inhibitor (PPI) (such as omeprazole, esomeprazole, or lansoprazole) along with two antibiotics – clarithromycin and amoxicillin. The PPI reduces stomach acid, making conditions less favorable for bacterial survival and improving antibiotic efficacy. Clarithromycin inhibits bacterial protein synthesis by binding to the 50S ribosomal subunit, while amoxicillin disrupts cell wall formation by targeting penicillin-binding proteins (PBPs), leading to bacterial death. However, due to increasing clarithromycin resistance, this therapy has become less effective in some regions.
- An alternative first-line option is bismuth quadruple therapy, particularly in areas with high clarithromycin resistance. This regimen includes a PPI, bismuth subsalicylate, tetracycline, and metronidazole. Bismuth compounds help protect the stomach lining and directly inhibit H. pylori, while tetracycline and metronidazole work together to eliminate the bacteria.
- Second-Line and Rescue Therapy
- For patients who fail first-line treatment, levofloxacin-based triple therapy is often used. This consists of a PPI, levofloxacin, and amoxicillin, offering an alternative antibiotic mechanism. In cases of multiple treatment failures, rifabutin-based therapy (PPI, rifabutin, and amoxicillin) may be considered, particularly for antibiotic-resistant H. pylori infections.
- Adjunctive and Alternative Approaches
- Several adjunctive therapies may enhance H. pylori eradication rates. Probiotics, such as Lactobacillus and Bifidobacterium species, may help reduce antibiotic side effects and improve treatment success. Some dietary interventions, like consuming broccoli sprouts (rich in sulforaphane) and green tea extracts, have shown potential antibacterial effects against H. pylori. Additionally, sequential or hybrid therapy, where antibiotics are administered in phases, has been explored to reduce resistance development.
- Overall, treatment selection depends on factors such as antibiotic resistance patterns, patient history, and regional guidelines. Continuous monitoring and the development of new therapies remain crucial to improving H. pylori eradication rates and reducing treatment failures.
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