Treatment of Helicobacter pylori Infection in Iran: Low Efficacy of Recommended Western Regimens

Several consensus guidelines have been formulated to aid the medical practitioner for therapy of Helicobacter pylori infection. While triple therapy with a proton pump inhibitor (PPI), in combination with two antibiotics administered for one week, is the established treatment of choice in many parts of the world, this regimen is far from optimal in Iran. The best results of Helicobacter pylori eradication in this country are obtained with two weeks of furazolidone-based quadruple therapy or clarithromycin based quadruple therapy. Given the high cost of clarithromycin, the former regimen is preferable as a first line treatment. Although documentation of cure is certainly needed for high risk patients (e.g., patients with complicated peptic ulcer or gastric mucosa associated lymphoid tissue), but it is reasonable for any patient who undergoes Helicobacter pylori eradication. Urea breath test 3 months after treatment is the recommended post-eradication testing. For failed treatment, two weeks of quadruple therapy containing a PPI, bismuth and two antibiotics should be used. If a clarithromycin-based regimen was used initially, a furazolidone-based regimen can be used afterwards, and vice versa. Culture and antibiotic susceptibility testing is not recommended unless after failure of second line treatment. The low eradication and higher reinfection rate of H. pylori in Iranian patients in comparison with patients in western countries shows that our H. pylori strains are probably more resistant than those in western countries