CHOICE OF ANTIMICROBIAL DRUGS FOR THE ERADICATION OF HELICOBACTER PYLORI INFECTION

Helicobacter pylori is the causative organism and has a possible role in the development of chronic peptic ulcer disease and gastric cancer. H. pylori is one of the most virulent pathogen to man. Despite the introduction of many new antimicrobial agents with enhanced activity against H. pylori, the high mortality rate associated with the organism in gastric cancer continues. H. pylori infection eradication is initiated for patients who are serological or UBT test positive and who have documented ulcer disease. Generally recommended regimens is the triple therapy with metronidazole and either bismuth sub-cylicylate or bismuth sub-citrate plus either amoxicillin or tetracycline for 14 days eradicates H. pylori infection in 70 – 95% of patients. Proton pump inhibitors directly inhibit H. pylori and appear to be potent urease inhibitors. Regimens to eradicate H. pylori are continually evolving; metronidazole and clarithromycin resistant strains are now common in many countries. In patients with gastric ulcer, a careful NSAID history is also important. The aim of this paper is to review some of the main regimens for the eradication of H. pylori infection.