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lüll A new look at anti-Helicobacter pylori therapy Chuah SK; Tsay FW; Hsu PI; Wu DCWorld J Gastroenterol 2011[Sep]; 17 (35): 3971-5With the rising prevalence of antimicrobial resistance, the treatment success of standard triple therapy has recently declined to unacceptable levels (i.e., 80% or less) in most countries. Therefore, several treatment regimens have emerged to cure Helicobacter pylori (H. pylori) infection. Novel first-line anti-H. pylori therapies in 2011 include sequential therapy, concomitant quadruple therapy, hybrid (dual-concomitant) therapy and bismuth-containing quadruple therapy. After the failure of standard triple therapy, a bismuth-containing quadruple therapy comprising a proton pump inhibitor (PPI), bismuth, tetracycline and metronidazole can be employed as rescue treatment. Recently, triple therapy combining a PPI, levofloxacin and amoxicillin has been proposed as an alternative to the standard rescue therapy. This salvage regimen can achieve a higher eradication rate than bismuth-containing quadruple therapy in some regions and has less adverse effects. The best second-line therapy for patients who fail to eradicate H. pylori with first-line therapies containing clarithromycin, amoxicillin and metronidazole is unclear. However, a levofloxacin-based triple therapy is an accepted rescue treatment. Most guidelines suggest that patients requiring third-line therapy should be referred to a medical center and treated according to the antibiotic susceptibility test. Nonetheless, an empirical therapy (such as levofloxacin-based or furazolidone-based therapies) can be employed to terminate H. pylori infection if antimicrobial sensitivity data are unavailable.|Amoxicillin/pharmacology/therapeutic use[MESH]|Anti-Infective Agents/*pharmacology/*therapeutic use[MESH]|Bismuth/pharmacology/therapeutic use[MESH]|Clarithromycin/pharmacology/therapeutic use[MESH]|Drug Resistance, Bacterial[MESH]|Drug Therapy, Combination[MESH]|Helicobacter Infections/*drug therapy[MESH]|Helicobacter pylori/*drug effects[MESH]|Humans[MESH]|Levofloxacin[MESH]|Metronidazole/pharmacology/therapeutic use[MESH]|Ofloxacin/pharmacology/therapeutic use[MESH]|Tetracycline/pharmacology/therapeutic use[MESH] |