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Gastroenterology Research and Practice
Volume 2012 (2012), Article ID 168361, 8 pages
http://dx.doi.org/10.1155/2012/168361
Review Article

The Optimal First-Line Therapy of Helicobacter pylori Infection in Year 2012

1Division of Gastroenterology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan
2Department of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
3Cancer Center, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan
4Department of Health Management, I-Shou University, E-Da Hospital, Kaohsiung County 824, Taiwan
5Department of Public Health, College of Health Sciences, Kaohsiung Medical University, Kaohsiung City 807, Taiwan
6Division of Infectious Diseases, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung City 807, Taiwan
7Division of Endocrinology and Metabolism, Department of Internal Medicine, Changhua Christian Hospital, Changhua 500, Taiwan

Received 29 February 2012; Accepted 17 April 2012

Academic Editor: Ping-I Hsu

Copyright © 2012 Chao-Hung Kuo et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

This paper reviews the literature about first-line therapies for H. pylori infection in recent years. First-line therapies are facing a challenge because of increasing treatment failure due to elevated antibiotics resistance. Several new treatment strategies that recently emerged to overcome antibiotic resistance have been surveyed. Alternative first-line therapies include bismuth-containing quadruple therapy, sequential therapy, concomitant therapy, and hybrid therapy. Levofloxacin-based therapy shows impressive efficacy but might be employed as rescue treatment due to rapidly raising resistance. Rifabutin-based therapy is also regarded as a rescue therapy. Several factors including antibiotics resistance, patient compliance, and CYP 2C19 genotypes could influence the outcome. Clinicians should use antibiotics according to local reports. It is recommended that triple therapy should not be used in areas with high clarithromycin resistance or dual clarithromycin and metronidazole resistance.