Third-Line Eradication Therapy

摘要: The success rates of Helicobacter pylori eradication treatment may be decreasing in clinical practice, mainly because the widespread use antibiotics. Fortunately, resistance to amoxicillin, tetracycline, and rifabutin has remained low. After failure second-line treatment, subsequent should guided by antimicrobial susceptibility testing whenever possible. With addition newer rapid molecular tests detect H. determination presence point mutations, resistance-guided therapy play a more important role future. During empirical third-line therapy, antibiotics used previously avoided. Third-line options include fluoroquinolone, rifabutin, furazolidone, high-dose proton pump inhibitor/amoxicillin therapy. Sitafloxacin shows activities 8–16-fold or greater than those levofloxacin could overcome with gyrA mutations. However, sitafloxacin is not widely available many countries predominantly been employed Japan. reserved for multiresistant Mycobacterium tuberculosis strains, so that preferably only as last resort after clarithromycin, metronidazole, fluoroquinolone have failed eradicate pylori.