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Molecules 2015, 20(4), 6068-6092; doi:10.3390/molecules20046068

Appropriate First-Line Regimens to Combat Helicobacter pylori Antibiotic Resistance: An Asian Perspective

1
Department of Environmental and Preventive Medicine, Oita University Faculty of Medicine, Yufu 879-5593, Japan
2
Gastroentero-Hepatology Division, Department of Internal Medicine, Airlangga University Faculty of Medicine, Surabaya 60131, Indonesia
3
Institute of Tropical Disease, Airlangga University, Surabaya 60115, Indonesia
4
Department of Gastroenterology and Hepatology, Baylor College of Medicine and Michael DeBakey Veterans Affairs Medical Center, Houston, TX 77030, USA
*
Author to whom correspondence should be addressed.
Academic Editor: Peter J. Rutledge
Received: 25 February 2015 / Revised: 20 March 2015 / Accepted: 2 April 2015 / Published: 8 April 2015
View Full-Text   |   Download PDF [775 KB, uploaded 8 April 2015]   |  

Abstract

Asia has the largest population of any continent and the highest incidence of gastric cancer in the world, making it very important in the context of Helicobacter pylori infection. According to current guidelines, standard triple therapy containing a proton pump inhibitor (PPI) and two antibiotics; amoxicillin (AMX) and clarithromycin (CAM) or metronidazole (MNZ), is still the preferred first-line regimen for treatment of H. pylori infection. However, the efficacy of legacy triple regimens has been seriously challenged, and they are gradually becoming ineffective. Moreover, some regions in Asia show patterns of emerging antimicrobial resistance. More effective regimens including the bismuth and non-bismuth quadruple, sequential, and dual-concomitant (hybrid) regimens are now replacing standard triple therapies as empirical first-line treatments on the basis of the understanding of the local prevalence of H. pylori antimicrobial resistance. Selection of PPI metabolized by the non-enzymatic pathway or minimal first pass metabolism and/or increasing dose of PPI are important to increase H. pylori eradication rates. Therefore, local antibiotic resistance surveillance updates, selection of appropriate first-line regimens with non-enzymatic PPI and/or increased doses of PPI, and detailed evaluation of patients’ prior antibiotic usage are all essential information to combat H. pylori antibiotic resistance in Asia. View Full-Text
Keywords: Helicobacter pylori; Asia; antibiotic resistance; clarithromycin (CAM); amoxicillin (AMX); metronidazole (MNZ); proton pump inhibitor (PPI); CYP2C19 polymorphisms Helicobacter pylori; Asia; antibiotic resistance; clarithromycin (CAM); amoxicillin (AMX); metronidazole (MNZ); proton pump inhibitor (PPI); CYP2C19 polymorphisms
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. (CC BY 4.0).

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MDPI and ACS Style

Miftahussurur, M.; Yamaoka, Y. Appropriate First-Line Regimens to Combat Helicobacter pylori Antibiotic Resistance: An Asian Perspective. Molecules 2015, 20, 6068-6092.

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