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What is the best first-line therapy for Helicobacter pylori infection?

Nature Clinical Practice Gastroenterology & Hepatology volume 5, pages 606–607 (2008)Cite this article

Helicobacter pylori (H. pylori) infection is the main cause of peptic ulcer and gastric neoplasia worldwide, and represents a major public health problem.1 For many years, standard treatment has been triple therapy (the combination of a PPI, amoxicillin and clarithromycin, all twice daily for 7–14 days). Lately, however, reports of unsatisfactory cure rates have multiplied, and pooled data suggest that global cure rates with triple therapy are below 80%.1 Dissatisfaction with this treatment strategy is growing, and alternatives are being actively sought.1

The first option for improving the results of first-line H. pylori therapy is to improve the efficacy of triple therapy by increasing treatment duration and/or the dose of PPI. Additional possibilities for first-line therapy are: levofloxacin-based triple therapy; adding probiotics or prebiotics to standard triple therapy; and using four instead of three drugs together, either as classical quadruple therapy, 'sequential' therapy, or 'concomitant' treatment.

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Acknowledgements

I am indebted to Michael Maudsley for his help with the English in this article, and to Javier Pérez Gisbert, Fernando Gomollón, and the Sabadell Gastro team for their critical review of the manuscript. CIBERehd is funded by the Instituto de Salud Carlos III.

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  1. Unitat de Malalties Digestives, Hospital de Sabadell, Institut Universitari Parc Taulí, Departament de Medicina, UAB, CIBERehd, Instituto de Salud Carlos III, Parc Taulí s/n, 08208 Sabadell, Barcelona, Spain xcalvet@cspt.es

Authors and Affiliations

  1. Barcelona. He is also an Associate Professor in the Department of Medicine at the Universitat Autònoma de Barcelona, X Calvet is a Consultant in Gastroenterology and Coordinator of the Gastroenterology Research Team of the Centro de Investigación Biomédica en Red (CIBERehd) at the Hospital de Sabadell, Barcelona, Spain.,

    Xavier Calvet

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Competing interests

Xavier Calvet has received research funding from Astra Zeneca and Janssen-Cilag. He is also on the speaker's bureau for Astra Zeneca and Almirall Prodesfarma.

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Calvet, X. What is the best first-line therapy for Helicobacter pylori infection?. Nat Rev Gastroenterol Hepatol 5, 606–607 (2008). https://doi.org/10.1038/ncpgasthep1252

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