Recommendations of the Maastricht V/Florence consensus for the Helicobacter pylori infection treatment

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The purpose of the work is to analyze section of the Maastricht-V-Florence consensus dedicated of Helicobacter pylori (H.pylori) infection treatment. H. pylori resistance rates to antibiotics are increasing in most parts of the world. For any regimen, the eradication rate can be predicted if the cure rates are known for susceptible and resistant strains and the prevalence of resistance in the population. For an individual patient a history of any prior use of one of the key antibiotics proposed will identify likely antibiotic resistance despite low resistance rates in the population. Susceptibility based results simultaneously provide results that are both population- and individual-based. In areas of high (>15%) clarithromycin resistance, bismuth quadruple or non-bismuth quadruple, concomitant (proton pump inhibitor - PPI, amoxicillin, clarithromycin and a nitroimidazole) therapies are recommended. In areas of high dual clarithromycin and metronidazole resistance, bismuth quadruple therapy is the recommended first-line treatment. The treatment duration of bismuth quadruple therapy should be extended to 14 days, unless 10 day therapies are proven effective locally. The treatment duration of triple therapy with clarithromycin should be extended to 14 days. In areas of low clarithromycin resistance, triple therapy is recommended as first-line empirical treatment. Bismuth-containing quadruple therapy is an alternative. The use of high dose PPI twice daily increases the efficacy of triple therapy. Esomeprazole and rabeprazole may be preferred in Europe and North America where the prevalence of PPI extensive metabolisers is high. After failure of bismuth-containing quadruple therapy, a fluoroquinolone-containing triple or quadruple therapy may be recommended. In cases of high quinolone resistance, the combination of bismuth with other antibiotics, or rifabutin, may be an option. In general, when compared with the previous consensus, for the treatment of H. pylori infection more aggressive antibiotic therapy is offered.

About the authors

S. I Pimanov

Vitebsk State Order of Peoples' Friendship Medical University

Email: pimanovs@tut.by
д-р мед. наук, проф., зав. каф. терапии №2 фак-та повышения квалификации и переподготовки кадров УО 210023, Republic of Belarus, Vitebsk, pr-t Frunze, d. 27

E. V Makarenko

Vitebsk State Order of Peoples' Friendship Medical University

д-р мед. наук, проф. каф. терапии №2 фак-та повышения квалификации и переподготовки кадров УО 210023, Republic of Belarus, Vitebsk, pr-t Frunze, d. 27

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