Current concepts in the treatment of H. pylori infection and H. pylori vaccines

Eun, Chang Soo; Han, Dong Soo

Abstract

Seven day regimen of proton pump inhibitor (PPI)-clarithromycin-amoxicillin triple therapy has been the main first line therapy for H. pylori infection. However, recently, the efficacy of this triple therapy becomes lower and the main cause of treatment failure is antibiotic resistance. As a first line treatment option, extended treatment duration and new treatment regimen, such as quadruple therapy, need to be considered. In the case of first line treatment failure, quadruple therapy consisting of PPI-bismuth-tetracycline-metronidazole is an effective second line regimen. After the failure of a second line treatment, rescue treatment should be based on antimicrobial susceptibility testing. Triple therapies based on levofloxacin, moxifloxacin, or rifabutin are options if multiple eradication failure occurs. Several problems of drug treatment for H. pylori infection, such as antibiotics resistance and high re-infection rates, would be overcome by the use of an efficacious vaccine. Although extensive studies in the mouse model have demonstrated the feasibility of both therapeutic and prophylactic vaccine, few clinical trials with various formulations have provided satisfactory results. To develop a successful vaccine, better understanding of the mechanism of the immune response to H. pylori infection as well as more information on suitable antigens, route of immunization, and adjuvants will be required.