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Retreatment of helicobacter pylori infection after initial treatment failure

OBJECTIVES:Helicobacter pylori treatment regimens fail to cure the infection in at least 10–20% of patients undergoing initial treatment. Retreatment strategies for patients who have failed initial treatment for H. pylori infection remain poorly described.METHODS:The literature describing the frequency of H. pylori treatment failure and factors leading to failure is reviewed. The role of antibiotic resistance is discussed and clinical studies assessing success rates according to antibiotic resistance are described. Clinical trials evaluating the treatment success rates for a second episode of treatment are discussed.RESULTS:The literature describing retreatment of failed H. pylori infection remains limited. The existing data support the use of bismuth-based quadruple therapy or ranitidine bismuth citrate (RBC)–based triple therapy as the preferred agents after initial treatment failure.CONCLUSION:Further studies are needed to better define the optimal second treatment regimen after failed H. pylori treatment.