Eradication therapy of Helicobacter pylori. A review. Report from a workshop organized by the Swedish and Norwegian Medical Products Agencies, September 1995.

An expert meeting was organized by the Swedish and Norwegian Medical Products Agencies in September 1995 in order to review the current literature and opinions on detection and treatment of Helicobacter pylori. Ten people from these Agencies and 23 experts participated in the workshop and all were involved in the final manuscript, summarizing the background data and the conclusions (Info Läkemedelsverket 1:96). This report is limited to the therapeutic issues. Therapeutic effect on H. pylori is shown for tetracyclines, nitroimidazoles, clarithromycin, and amoxicillin. Acid inhibitory drugs or bismuth salts increase the antibacterial activity. In vitro resistance to metronidazole is reported in cultures of 10%-40% of H. pylori-infected patients in Scandinavia. Primary resistance to clarithromycin and tetracyclines is rare and no resistance to amoxicillin is confirmed. The clinical significance of resistance is unclear when effective triple combinations are used in previously untreated patients, but should be considered in treatment failures. Recommended therapeutic regimens should achieve a more than 90% cure rate. Important factors when choosing therapy are efficacy, side-effects, ecological factors, duration of therapy, and cost-benefit. Four triple regimens are effective and relatively well documented: omeprazole/amoxicillin/metronidazole for 1 week, omeprazole/clarithromycin/metronidazole for 1 week, omeprazole/clarithromycin/amoxicillin for 1 week, or bismuth subnitrate or bismuth citrate/tetracycline/metronidazole for 10 days. Side-effects are less pronounced in the combinations without bismuth. Dual therapy is not recommended. Eradication therapy should be considered for patients with peptic ulcer disease, MALT-lymphoma and Menetriéré's disease. Triple combinations, including two antimicrobials and a potent acid inhibitory drug or bismuth, are recommended.