Helicobacter pylori therapy: what is coming?

Abstract

Helicobacter pylori infection is a widespread disease causing significant morbidity and mortality, with a relevant economic impact. To cure such an infection, the use of a 7-day triple therapy (a proton pump inhibitor together with two antibiotics) is suggested in those areas in which clarithromycin resistance rate is < 20%, whereas a 7-day quadruple therapy or a 14-day triple therapy should be used where clarithromycin resistance is higher. However, no existing therapies achieve bacterial eradication in all treated patients, the eradication rate can actually reach values as low as 70 – 80%. Therefore, new drugs are vital within this field. Surprisingly, very few patents have been claimed in the last three years. Quinolone derivatives probably remain the most investigated drugs, gemifloxacin being proposed most recently. New pleuromutilin derivatives (I-valnemulin) showed a very powerful bacteriocidal activity against H. pylori isolates, but in vivo data are still lacking. A novel proton pump inhibitor – the (-)-enantiomer of tenatoprazole – with reduced nocturnal acid breakthrough values has been claimed. This compound might improve activity of the antibiotic dose administered at bedtime.

Keywords::

• Helicobacter pylori
• proton pump inhibitor