Comparison of Three Triple Therapies in the Eradication of Helicobacter pylori

The eradication of Helicobacter pylori infection has proved difficult. As with other chronic infections, evasion of the immune response may be a major factor contributing towards the persistence of infection and the difficulty in eradication with antimicrobials. Although H. pylori can be suppressed with single antibiotic therapy, recrudesence of the infection following the cessation of treatment is the rule [1, 2]. This occurs despite a high in vitro sensitivity of H. pylori to various single antibiotics [3] and apparent therapeutic mucosal antibiotic levels [4, 5]. The resistence to antibiotic therapy may be due to (a) diminished antibiotic activity in the acid environment of the stomach; (b) the development of resistent forms of H. pylori; and (c) the antibiotics not reaching the bacteria in its protected niche under the mucous layer. It is obviously difficult to determine if an antibiotic has reached a precise niche [4]; however, adequate therapeutic mucosal antibiotic levels appear to have been achieved. This would seem to suggest that lack of assistance from an immune response may be a significant factor in failure of single antibiotic therapy.