The role of clarithromycin in modern Helicobacter pylori eradication therapy regimens

Helicobacter pylori infection can serve as one of indications to clarithromycin prescription. H. pylori eradication is performed commonly as a treatment for diseases caused by this pathogen and conditions with an increased risk of complications (precancerous changes of the gastric mucosa, unspecified iron deficiency anemia, idiopathic thrombocytopenic purpura, long-term NSAIDs use, anti-platelet drugs use etc). A number of H. pylori functional characteristics determines specific requirements for eradication schemes: high sensitivity of the pathogen, the ability of antibacterial drugs to penetrate and accumulate in gastric tissue and mucous,a stimulation of microorganism’s reproduction and protection of acid-resistant drugs by reducing gastric acid production as well. If the latter is provided by the use of proton pump inhibitors, then clarithromycin fully provides the other issues above. In Russia, standard triple therapy is used as the first-line treatment of H. pylori infection due to current clarithromycin resistance less than 15%. The article gives detailed reasoning and factual evidence of commitment to the first-line therapy under the increasing prevalence of the most recent antibiotic resistance (local resistance to levofloxacin has reached 20%), the high potential for multi-drug resistant H. pylori strains appearing, low ensuring medical facilities with relevant resistance test-systems, a role of generic drugs (clarithromycin and proton pump inhibitors) with compromised pharmaceutical characteristics in creation and erroneous interpretation of a pseudoresistance to clarithromycin.

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