Safety and Efficacy of Triple and Quadruple Regimens as First Line Therapy for Management of Helicobacter Pylori Infection in Egyptians

Helicobacter pylori (H. pylori) is a globally prevalent pathogen which infects about over 50% of population. However, not all cases have clinical symptoms, H. pylori are described as gram negative bacteria which causes ulcers in the lining of stomach or the upper part of small intestine. For some patients, a progressive infection can cause gastric cancer which is the second widespread cancer worldwide (1).

While this pathogen in Egypt is a public health issue, the propagation of H. pylori infection is approximately 80% (2), study results concluded that H. pylori infection in upper Egypt was higher than in urban areas (3).

Transmission modes of H. pylori are very controversial, the reservoir of H. pylori is the human stomach. The main method of acquisition in both developing and developed countries by fecal oral route, whereas the other route of transmission in developed countries is the gastro-oral route mainly water borne prevalence, overcrowding of the family of large number members, institutionalized children are predisposing for acquiring the infection. (4:6), and occupational risk factor for health members, in particular those working in gastrointestinal units (7). Over spread of the infection in upper Egypt could be due to the hygiene level, socioeconomic conditions, life style, and absence of sources of pure water supply in rural areas (3).

H. pylori has been classified as one of the 12 bacterial species need high priority future strategies for new antibiotic development by the World Health Organization (WHO), management of H. pylori is widely debatable due to high antibiotics resistance prevalence after exclusion of inadequate gastric suppression by proton pump inhibitor and poor adherence to the therapy. Furthermore, the efficacy of many regimens has declined due to increased antibiotic resistance making H. pylori eradication challenging, H. pylori treatment has been complicated and has required 10 and 14 days of multiple daily doses of three or four different medicines. (8:13).

There is no worldwide accepted regimen for the eradication of H. pylori infection. Standard triple therapy (STT) with proton pump inhibitors (PPI) in standard dose, clarithromycin (500 mg), and amoxicillin (1 g) twice daily for 14 days is the standard triple first line regimen in the published international guidelines of the European Helicobacter and Microbiota Study Group in areas of low clarithromycin resistance (14).