J Med Assoc Thai 2021; 104 (7):96-102

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Current and Future Perspectives on Helicobacter pylori Antibiotic Resistant Mechanisms and Therapeutic Regimens
Hinthong W Mail

Helicobacter pylori (H. pylori) is an important cause of gastritis, gastric and duodenal ulcer and even gastric cancer worldwide. Its resistance to antibiotics has greatly affected the eradication rates of the bacteria, making it more challenging to cure infected patients with first-line therapy. The first-line therapy consists of standard triple therapy, sequential therapy, concomitant therapy and bismuth-containing quadruple therapy, which usually involves proton pump inhibitor and many antibiotics such as clarithromycin, metronidazole, amoxicillin and tetracycline. Notably, H. pylori has been reported to show resistance to all of these antibiotics. The second-line therapies usually involve levofloxacin, and studies have also reported levofloxacin-resistant H. pylori strains. Novel therapeutic regimens including the use of probiotics in conjunction with antibiotics could be a promising new therapeutic regimen; however, further study regarding potential side effects, cost effectiveness and efficacy of the regimen is still needed. This review discusses current information on antibiotic resistant mechanisms and the novel therapeutic regimens for H. pylori infection.

Keywords: Helicobacter pylori, Antibiotic resistance, Therapeutic regimens

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