Eradication of Helicobacter Pylori

Since the discovery of Helicobacter pylori just over 15 years ago, the treatment of peptic ulcer disease has been revolutionized. H. pylori is an important causative factor for the development of duodenal and gastric ulcers. Because H. pylori can be eradicated with very low rates of ulcer recurrence, antibiotic therapy is now recommended by the National Institutes of Health (NIH) and the American College of Gastroenterology for all H. pylori-positive ulcer patients. Bismuth subsalicylate, antibiotics (amoxicillin, tetracycline, metronidazole, and clarithromycin), proton pump inhibitors, and H₂ blockers are the standards for treatment. They are combined in dual, triple, and quadruple therapy regimens to produce H. pylori eradication. All of the phamacologic agents currently prescribed for H. pylori eradication are associated with bothersome adverse effects and numerous documented and potential drug interactions. Because no gold standard for H. pylori eradication exists, the treatment decision must be on the basis of efficacy, cost, compliance, tolerability, antimicrobial resistance, and potential drug interactions.