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Treatment of Helicobacter pylori infection

BMJ 2000; 320 doi: (Published 03 June 2000) Cite this as: BMJ 2000;320:1540

Development of resistance to antibiotics used must be avoided

  1. G Gopal Rao, consultant microbiologist. (,
  2. J O'Donohue, consultant gastroenterologist.,
  3. C S Mahankali Rao, research coordinator, microbiology department.,
  4. H Fidler, consultant gastroenterologist.
  1. University Hospital Lewisham, London SE13 6LH
  2. South Durham Health Care NHS Trust, Bishop Auckland General Hospital, Bishop Auckland, County Durham DL14 6AD
  3. Dipartimento di Medicina Interna e Specialità Mediche, Università di Genova, n6-16132 Genova, Italy
  4. Dipartimento di Medicina e Scienze dell'Invecchiamento, Università di Chieti, Policlinico Colle dell'Ara, 66100 Chieti, Italy
  5. Istituto di Medicina Interna e Geriatria, Università di Palermo, 90127 Palermo, Italy

    EDITOR—We agree with de Boer and Tytgat that treatment to eradicate Helicobacter pylori in patients with proved peptic ulcer is cost effective and benefits the patient and society.1 Treatment to eradicate the organism in patients with non-ulcer dyspepsia, however, is contentious. The efficacy, safety, and cost effectiveness are far from proved. Several recent trials, including a multicentre double blind placebo controlled trial, failed to show any significant long term benefit of H pylori eradication treatment in non-ulcer dyspepsia.2 3

    In our hospital 12 patients with dyspepsia who had previously received treatment from their general practitioners to eradicate H pylori on the basis of positive serological results were found to have gastric carcinoma. In several cases the delay in referring the patients to a gastroenterologist was considerable (unpublished observations).

    Perhaps the most compelling reason to desist from empirical or indiscriminate antibiotic treatment of non-ulcer dyspepsia is the recent observation that commensal oral and bowel flora rapidly develop resistance to antibiotics (clarithromycin, amoxycillin, and metronidazole) used in H pylori eradication treatment. The emergence and persistence of resistant strains was most pronounced in patients …

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