Treatment of Antibiotic-ResistantHelicobacter pyloriInfection

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Abstract
In 1996, several European gastroenterologists recommended that first-line treatment of Helicobacter pylori infection should consist of a proton-pump inhibitor combined with two of the following: clarithromycin, a nitroimidazole (metronidazole or tinidazole), and amoxicillin.1 In the case of treatment failure, either a second course of this triple regimen or quadruple therapy (omeprazole plus bismuth-based triple therapy) is advisable. However, because patient compliance with and tolerance of quadruple therapy is low, alternative treatments are needed for patients who have had no response to two or more courses of a standard triple regimen.