Leading Article: Leading Article Anti-infectives: Prospects for improved therapy for Helicobacter pylori infection

Abstract

Cure of Helicobacter pylori infection has been recommended for patients with peptic ulcer disease. However, an optimal treatment regimen has not been defined. Dual therapy regimens with omeprazole and amoxycillin or clarithromycin usually achieve eradication rates of 70 - 80%, while a combination of ranitidine bismuth citrate and clarithromycin produces eradication rates of over 80%. Triple therapy with a bismuth salt plus metronidazole and tetracycline or amoxycillin (the standard bismuth-based triple therapy), or a proton pump inhibitor (PPI-based therapy) plus two antimicrobial agents (metronidazole, amoxicillin or clarithromycin) is effective in eradicating H. pylori, with eradication rates of over 90% for metronidazole-sensitive strains. Drug resistance and compliance influence the clinical efficacy. Addition of a PPI to bismuth-based triple therapy (quadruple therapy) may overcome drug resistance, reduce side-effects, and shorten the treatment duration, but compliance may be reduced. Therefore, the search for a simple and effective therapy continues. Novel approaches include alternative types of drug administration (topical or parenteral), substitution with more powerful analogues or novel agents such as enzyme-inhibitors, Chinese herbs, honey, lactic acid and unsaturated fatty acids. Recently, vaccines against H. pylori infection have been developed and tested in animal models. The studies have demonstrated that oral immunisation with H. pylori whole cell sonicates or recombinant urease of the organism not only prevents the infection but can also eradicate it. Thus, therapeutic vaccines, which we believe are achievable, may finally eliminate H. pylori from the human stomach, and therefore cure most peptic ulcer disease.

Key Words:

• Helicobacter pylori
• therapy
• antimicrobials
• vaccines