Treatment of Helicobacter pylori

Table 1 Risk factors for nitroimidazole resistance in H. pylori

□ Previous use of nitroimidazoles, e.g. gynaecological infections, infective diarrhoeas

□ Failed H. pylori eradication regimen containing a nitroimidazole

□ Urban or inner city areas

□ Patients born in emergent countries

Table 2 Low dose triple therapy

Therapy	PPI or RBC	PPI or RBC
	Amoxycillin	Clarithromycin
	Clarithromycin	Metronidazole
Dosing	b.d.	b.d.
	1 g b.d.	250 mg b.d.
	500 mg b.d.	400 mg b.d.
Duration		One week
Side effects	Nausea, diarrhoea, taste disturbances
H. pylori eradication	90%	90% in MSS
		75% in MRS

PPI: Proton pump inhibitor; RBC: Ranitidine bismuth citrate; b.d.: Twice daily; MSS: Metronidazole-sensitive strain of H. pylori; MRS: Metronidazole-resistant strain of H. pylori

Table 3 Quadruple therapy

Therapy	Omeprazole
	Colloidal bismuth subcitrate
	Tetracycline
	Metronidazole
Dosing	o.d.
	120 mg q.d.s.
	500 mg q.d.s.
	400 mg q.d.s.
Duration	One week
Side effects	Common: nausea, diarrhoea, taste disturbances
H. pylori eradication	＞ 75% in MRS
	＞ 90% in MSS

o.d.: Once daily; q.d.s.: Four times daily; MRS: Metronidazole-resistant strains of H. pylori; MSS: Metronidazole-sensitive strains of H. pylori

Table 4 Current indications for H. pylori eradication therapy

Diagnosis	Established evidence-based indications
Non-NSAID DU	+
Non-NSAID GU	+
NSAID DU or GU	-
Functional dyspepsia	+ or ?
GORD	-
Risk of gastric cancer	+ or ?
MALT lymphoma	+

Key: +, good/excellent evidence in favour of treatment; -, unclear or negative outcome from treatment; ?, equivocal or mild benefit in favour of treatment