Therapy of Helicobacter pylori infection

Despite a multitude of clinical trials during the past year, no one therapeutic regimen has clearly emerged as the optimal treatment for Helicobacter pylori infection. A 1-week course with a twice daily combination of a proton pump inhibitor and two antibiotics has produced consistently high eradication rates. The effect of primary antimicrobial resistance on the efficacy of these regimens has yet to be clarified. Variability of laboratory techniques used to assess resistance in vitro in H. pylori may be responsible for the discrepancy in the results to date. Quadruple therapy, consisting of classical bismuth triple therapy and a proton pump inhibitor has been shown to be highly effective, even in the presence of metronidazole resistance and after failure of other therapies. The search for the 'magic bullet', however, continues.