Sequential, Concomitant and Hybrid regimens for Helicobacter pylori.
7-day conventional triple therapy is not working in a satisfactory way in many parts of the world. New regimens have been proposed for first-line therapy and their outcome appears to be improved. Do you think that there is still a margin for conventional 7-day triple therapy or now is the moment to change guidelines? Experiences and opinions from different geographic areas are welcome.
I agree with both opinions, my friends, mainly for future pespectives which are not optimistic: increasing resistances and no new available antibiotics. The strategy proposed by Amin is obiously "the future" and it is desirable that the future will arrive as soon as possible. But how do you think to realize a characterization of the bacterium in vitro in primary care? How long do the patients have to wait before a theraprutic medical presdription? And how many laboratories will be able to do culture and antibiogram? There will be a problem of costs? Dear Amin, I agree with you, but how many problems in the daily medical practice!
Dear Abdalla, the paper you cited is from my group and was the input that stimulated the discussion, I hope there will be about this intersting an actual topic.
I agree with both opinions, my friends, mainly for future pespectives which are not optimistic: increasing resistances and no new available antibiotics. The strategy proposed by Amin is obiously "the future" and it is desirable that the future will arrive as soon as possible. But how do you think to realize a characterization of the bacterium in vitro in primary care? How long do the patients have to wait before a theraprutic medical presdription? And how many laboratories will be able to do culture and antibiogram? There will be a problem of costs? Dear Amin, I agree with you, but how many problems in the daily medical practice!
Dear Abdalla, the paper you cited is from my group and was the input that stimulated the discussion, I hope there will be about this intersting an actual topic.
Very interesting point. We are looking forward to read your next paper. However, i should ask you a last question: what is your favourite first line regimen at the moment?
I agree. My group first started sequential therapy even in children about 10 years ago and CLA resistance is at the moment the main reason of theraputic failure (see attachement). You probably already know it. I see that you do not give more a margin for triple therapy. It's also my opinion, but it is very hard to obtain the approvation of experts of last Maastricht Guidelines. I spent a long time to discuss this aspect with them and encountered a strong resistance to leave triple therapy scheme.
I should like to ask the opinion of all question followers, by a simple expression regarding the therapeutic regimen state: alive or dead.
@Amin, my compliments for your "snart therapy".
Lerardi Enzo,
What do you think of immunomodulation for H.pylori treatment? Is chronic H.pylori infection due to over stimulation of th2 or th1? Dr. Marshall now uses an extract from H.pylori to treat children with allergies. Well, we can use the same logic to treat H.pylori. Antibiotics are not the answer, and we will be short of them soon due to bacterial resistance. They are failing to treat many infections and doctors and clinicians working in private practice and hospitals can attest to this fact. Drugs used to treat pneumonia few decades are becoming useless nowadays.
The dimension we have to look at is the microbiome. Why some people are fine with H.pylori? Why the same members of the same family do not react the same way to H.pylori infection?
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