Variability in the outcome of treatment of Helicobacter pylori infection: a critical analysis

There have been hundreds of studies involving various combinations of antimicrobial and antisecretory drugs, to identify the ‘best’ method of curing Helicobacter pylori infection. In some instances (e.g. the combination of a proton-pump inhibitor and amoxycillin) the results have been extremely variable; in others the results have been relatively consistent (e.g. a proton-pump inhibitor, clarithromycin, and metronidazole)1-4. This chapter attempts to address why this occurs. Early experiments showed that H. pylori infection requires more than one drug; reliable treatment required combinations of antibiotics or combinations of antimicrobials and antisecretory agents. H. pylori is a mucosal infection, and as such is ‘outside’ the body. What has been learned regarding the treatment of other bacterial infections of mucosal surfaces should, in general, apply to the treatment of H. pylori infections. However, the slow growth of H. pylori may explain (in part), the need to treat with multiple agents as compared with other enteric infections.