Novel therapeutic approaches to the management of Helicobacter pylori infection.

The eradication of Helicobacter pylori is indicated in a variety of conditions and the Maastricht consensus has recommended that first line regimens have an eradication rate of more than 80%. Present optimal first line therapy is proton pump inhibitor based triple therapy, but other regimens based on Ranitidine Bismuth Citrate may prove to be as effective, simple and well tolerated providing an alternative form of therapy. A variety of agents have been employed in various second line eradication regimens but no large scale trials have been conducted to establish the optimal second line regimen, following failure of standard line therapy. Novel antibiotics with activity against Helicobacter pylori are urgently required as resistance has developed to standard agents such as Clarithromycin and Metronidazole. Other agents such as the histamine receptor antagonist, Ebrotidine, and the proton pump inhibitor, Rabeprazole may have clinically important anti Helicobacter properties not merely related to their acid lowering effects. The ideal therapy would be safe effective vaccination but in the near future therapy is likely to be based on pharmacological agents taken orally.