Info

DU, duodenal ulcer; GU, gastric ulcer.

*Only misoprostol 800 mg/day has been directly shown to reduce the risk of ulcer complications such as perforation, hemorrhage, or obstruction.

DU, duodenal ulcer; GU, gastric ulcer.

*Only misoprostol 800 mg/day has been directly shown to reduce the risk of ulcer complications such as perforation, hemorrhage, or obstruction.

The emergence of resistance to clarithromycin and metronidazole increasingly is recognized as an important factor in the failure to eradicate H. pylori. Clarithromycin resistance is related to mutations that prevent binding of the antibiotic to the ribosomes of the pathogen and is an all-or-none phenomenon. In contrast, metronidazole resistance is relative rather than absolute and may involve several adaptations by the bacteria. In the presence of in vitro evidence of resistance to metronidazole, amoxicillin should be used instead. In areas with a high frequency of resistance to clarithromycin and metronidazole, a 14-day, quadruple-drug regimen (three antibiotics combined with a proton pump inhibitor) generally is effective therapy.

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