Helicobacter pylori: a clinical update

1. Summary, 126S 2. Introduction, 126S 3. The indications for anti‐Helicobacter pylori therapy, 126S 4. The optimum treatment for H. pylori, 127S 4.1 The optimum type of proton pump inhibitor for PPI triple therapy, 127S 4.2 The optimum dose of proton pump inhibitor for PPI triple therapy, 128S 4.3 The optimum dose of clarithromycin in PPI triple therapies, 128S 4.4 Comparing the efficacy of PAC and PCN, 128S 4.5 The anti‐H. pylori treatment of choice, 129S 5. Conclusions, 130S 6. References, 130S The aim of the study was to summarize the indications for H. pylori therapy and the optimum regimen to use. A review of the literature revealed that H. pylori eradication therapy is indicated in peptic ulcer disease, nonulcer dyspepsia and as part of an H. pylori test and treat strategy in uninvestigated dyspepsia. The optimum therapy to use was either a proton pump inhibitor (PPI) od, clarithromycin 250 mg bd, and metronidazole 400 mg bd (PCM) or a PPI bd, clarithromycin 500 mg bd and amoxycillin 1 g bd (PAC) for 7 d. The regimen containing metronidazole is cheaper but H. pylori may be more difficult to treat second line if initial therapy is unsuccessful. The indications for H. pylori eradication are widening and clarithromycin containing PPI triple therapy is the treatments of choice. This review suggests two optimum therapies for H. pylori. PAC is the treatment of choice for patients with peptic ulcer disease whereas PCM may be more cost‐effective for patients with non ulcer dyspepsia or uninvestigated dyspepsia.