Emerging Regimens for H. pylori Infection Should Enhance Efficacy and Circumvent Resistance

Excerpt

Treatment of H. pylori infection is complicated and often unsuccessful. Until recently, there had been few important advances in the ability to treat H. pylori infection. The pharmaceutical industry had not been focusing on this issue—although that may finally be changing. Most physicians in the USA do not have access to reliable antimicrobial sensitivity testing for H. pylori. Therefore, treatment is generally empiric—but should be based on some understanding of an individual patient’s previous antibiotic exposure and whether or not the patient is penicillin-allergic. Nevertheless, information about the former may be unavailable—and estimates of the latter are often grossly inflated; most patients claiming a history of penicillin “allergy” are not truly allergic [1]. Therefore, physicians may have to make treatment choices based on potentially unreliable information. Some patients who may have unknowingly received a macrolide antibiotic in the past may be treated with a clarithromycin-containing regimen for H. pylori infection; such treatment is likely to fail since H. pylori may have become clarithromycin-resistant. Some patients who incorrectly perceive they are “allergic” to penicillin may be inappropriately and unnecessarily deprived of amoxicillin as part of their treatment regimen. …