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With few exceptions, the most commonly recommended triple Helicobacter pylori regimen (proton pump inhibitor (PPI), amoxicillin and clarithromycin) now provides unacceptably low treatment success.
Drs David Graham and Lori Fischbach from Texas, USA performed a worldwide review, and found that successful eradication using a triple regimen is not consistently observed in any population.
The team reported tha clinicians should use ‘only use what works locally’ and ignore consensus statements and society guidelines if they are not consistent with local results.
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| Treatments needing further evaluation include furazolidone |
| Gut |
The team recommended that clinical trials should be result based, with the goal of identifying regimens with a higher than 90–95% success.
New treatments should be only be compared with the currently locally effective treatment (>90%) or a historical untreated control.
The team noted that trials using placebos or treatments known to be inferior are with rare exceptions unethical.
If a highly effective regimen is not available locally, the researchers recommend trying a 14 day concomitant quadruple treatment regimen containing a PPI, amoxicillin, clarithromycin and a nitroimidazole.
This is followed by a 10 day sequential treatment (PPI plus amoxicillin for 5 days followed by a PPI, clarithromycin and a nitroimidazole for 5 days, or 14 day bismuth-containing quadruple treatments.
Dr Graham and colleague concluded, "Treatments needing further evaluation include those containing furazolidone or nitazoxanide, hybrids of sequential–concomitant therapies and amoxicillin–PPI dual therapy with PPI doses such that they maintain intragastric pH over than 6."
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