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Gastroenterol Clin North Am. 2000 Dec;29(4):759-73, vii.

How to treat Helicobacter pylori. First-line, second-line, and future therapies.

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Laboratoire de Bactériologie, Université Victor Ségalen Bordeaux 2 and Hôpital Pellegrin, Bordeaux, France.


Numerous trials were performed in the 1990s to define the optimal therapy for Helicobacter pylori infections. The proposed proton-pump inhibitor (PPI)-based and ranitidine bismuth citrate (RBC)-based triple therapies led to satisfactory results. Their first drawback is cost, and, for this reason, many people worldwide cannot benefit from these regimens. Failures of first-line therapies essentially are because of antimicrobial resistance, which increases with the selection pressure resulting from the use of these drugs. Second-line treatments using antimicrobial agents for which H. pylori resistance is low or nonexistent are being tested to find alternatives to the quadruple therapy. There is a need for new drugs, which should be highly effective, nonselective of resistant strains, and without side effects, to improve current regimens. These drugs may be the results of postgenomic studies.

[Indexed for MEDLINE]

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