Hôpital Ambroise Paré,
9 Avenue Charles de Gaulle,
EA 4331 LITEC,
Université de Poitiers,
Laboratoire de Bactériologie-Hygiène,
CHU de Poitiers
Centre Hospitalier de Villeneuve St Georges,
94195 Villeneuve-Saint-Georges cedex
CHU de Nancy,
Hôpital Central, service de médecine interne,
Centre Hospitalier Annecy Genevois,
service d’hépato-gastroentérologie, 74374 Pringy
CNR des Campylobacters et Hélicobacters,
INSERM U1053-UMR BaRITOn,
33076 Bordeaux cedex
CHU Pellegrin, laboratoire de bactériologie,
Place Amelie Raba-Leon,
33076 Bordeaux cedex
CHRU Trousseau Chambray,
CHU de Guadeloupe,
service de microbiologie,
service de bactériologie,
It is necessary to update the recommendations for the treatment of H. pylori while eradication regimens have evolved and the frequency of resistance to antibiotics has increased. The two predicting factors of the eradication treatment are antibiotic resistant strains, particularly to clarithromycin, and low compliance. Consequently, the clinician must systematically ask the patient for prior treatment with macrolide or metronidazole, regardless of the indication, before prescribing an eradication treatment.
Culture-oriented treatments are associated with high rates of eradication. Given the potential of H. pylori to acquire resistances and the increasing prevalence of bacterial resistance, it is legitimate to propose a 14-day triple therapy with antibiotics adapted to susceptibility of the bacteria.
Probabilistic treatment must take into account the high prevalence of double metronidazole-clarithromycin resistance (15%). Optimized 14-day quadritherapy is required to achieve eradication rates above 90%. Quadritherapy containing bismuth is an alternative less dependent on bacterial resistances. According to the European consensus, it is the first-line recommended treatment in the countries where it is available.
Because of the prevalence of resistance, the use of tritherapies based on levofloxacin can not be recommended in France. After an eradication failure, levofloxacin can only be used on the basis of the results of an antibiotic susceptibility testing or a molecular technique for detecting resistances.
Multiple bacterial resistances to clarithromycin, metronidazole and fluoroquinolones in patients with bismuth quadritherapy failure may lead to the prescription of rifabutin, an expensive antibiotic with potentially severe adverse effects. It is advisable to reserve the use of rifabutin for formal indications and after a study of an antibiotic susceptibility testing. A validation by the multidisciplinary consultation meeting of the French Study Group of Helicobacter and the Helicobacter national reference center is advised.