Similar to any bacterial infection, the treatment of Helicobacter pylori infection is based on the use of antimicrobial agents. The first experiments performed during the early years after the discovery of H. pylori showed that no single agent could achieve its eradication at a sufficient rate. Dual antibiotic therapy increases the cure rate and avoids the selection of resistant strains. Despite these improvements, however, dual treatment was not efficient enough to be recommended for routine treatment.

An adjuvant therapy is needed, and until now the best adjuvant therapy has comprised drugs that increase the pH of the stomach (i.e., antisecretory drugs and especially proton-pump inhibitors [PPI]) because most antibiotics have a decreased activity at low pH.<sup>43 Mégraud F. Adjuvant therapy for Helicobacter pylori eradication: Role of lansoprazole shown in vitro J Clin Gastroenterol 1995 ;  20 (suppl 1) : S24-S27

Cliccare qui per andare alla sezione Riferimenti</sup> Three antibiotics have drawn special attention: (1) Clarithromycin, the best compound in the macrolide group, but it is costly and selects resistant strains; (2) amoxicillin, for which resistance is virtually absent, but it has a poor diffusion in gastric tissue; and (3) metronidazole, which has an excellent diffusion, but it induces and selects resistant strains. Because of these drawbacks, the success of the first-line therapies in practice is limited to 70% to 80%. Research now is focused on second-line therapies comprising a combination of other antibiotics with those previously cited; there is a need for new compounds specific for H. pylori, which should constitute future therapies.