Korean J Helicobacter Up Gastrointest Res.  2015 Jun;15(2):89-94. 10.7704/kjhugr.2015.15.2.89.

Recent Update on Third-line Helicobacter pylori Eradication

• Kim JH

• KMID: 2249855
• DOI: http://doi.org/10.7704/kjhugr.2015.15.2.89

Abstract

The eradication rate of Helicobacter pylori has been decreasing progressively, primarily due to increased resistance to antibiotics. The widely used standard clarithromycin-based triple therapy regimen is no longer achieving eradication rate of 80% in intent-to-treat analysis in many countries. Due to the primary and secondary resistance to metronidazole, the key antibiotic for second line regimen, eradication rate of standard metronidazole based quadruple therapy is also decreasing. It is rational to check antibiotic resistance for selecting regimens in third-line rescue eradication therapy, but it requires time and resource. Limited studies regarding the efficacy of a dual regimen consisting of high dose proton pump inhibitor and amoxicillin showed controversial results. Efficacy of rescue regimens containing fluoroquinolones, such as levofloxacin and moxifloxacin, were reported to be insufficient due to increasing incidence of primary and secondary resistance. Eradication result of third-line rescue regimens with sitafloxacin, a novel quinolone of which the antibacterial activity towards H. pylori is more than 100-fold that of ciprofloxacin in vitro, is promising. Although prevalence of serious side effect such as myelotoxicity with rifabutin-based rescue regimen is reported to be lower than expected, wider use of rifabutin is still concerned regarding the emergence of resistant mycobacterial species. Rifaximin based rescue regimen is safer and cheaper than rifabuitin based regimen. However, further investigation for better eradication rates by enhancing higher drug concentration in the gastric mucus layer needs to be evaluated.

Keyword

Helicobacter pylori; Third-line; Eradication

MeSH Terms

Amoxicillin
Anti-Bacterial Agents
Ciprofloxacin
Drug Resistance, Microbial
Fluoroquinolones
Helicobacter pylori*
Incidence
Levofloxacin
Metronidazole
Mucus
Prevalence
Proton Pumps
Rifabutin
Amoxicillin
Anti-Bacterial Agents
Ciprofloxacin
Fluoroquinolones
Metronidazole
Proton Pumps
Rifabutin