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Persistent H. Pylori Infection Presents Challenges

Clinicians urged to consider possibility of antibiotic resistance, pursue alternative strategies

FRIDAY, Oct. 3 (HealthDay News) -- New treatment strategies are needed to treat Helicobacter pylori infections that persist after standard treatment with antibiotics, according to an article published in the October issue of Clinical Gastroenterology and Hepatology.

Richard J. Saad, M.D., and William D. Chey, M.D., of the University of Michigan in Ann Arbor, described the case of a 35-year-old Hispanic woman with persistent H. pylori infection whose symptoms did not resolve despite two courses of treatment with a proton pump inhibitor, amoxicillin and clarithromycin. The authors said the case raises important questions about when and how H. pylori infection should be determined, which primary treatment option should be used, and which treatment options should be used for persistent H. pylori infection.

Saad and Chey faulted the case managers for initially prescribing only a seven-day course of treatment, which is associated with an eradication rate of less than 80 percent. Because the patient had an ulcer, they said that the managers should have relied on a urea breath test or monoclonal fecal antigen test instead of a serology test to confirm eradication. They also stated it was inappropriate to retreat the patient with the same regimen because she was at high risk of harboring a clarithromycin-resistant strain of H. pylori, which is associated with an eradication rate of less than 30 percent.

"Given the presence of persistent H. pylori infection, bismuth-based quadruple therapy or levofloxacin-based triple therapy for 10 to 14 days would be a reasonable next step to pursue," the authors conclude. "Follow-up testing with a urea breath test or monoclonal fecal antigen test should be scheduled no less than four weeks after the completion of therapy to confirm eradication of H. pylori."

Chey is on the speaker's bureau and is a consultant for Santarus, TAP Pharmaceuticals, and Takeda.

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