Infectious Disease Compendium

Helicobacter

Microbiology

Microaerophilic curved gram negative rods.

Epidemiologic Risks

Human to human from fecal oral OR oral oral. Spread not well worked out. In Japan it is spread from mother to child (PubMed).

H. pylori has been in humans as long as we have been a species and we may have given it to lions when they ate us 200,000 years ago (PubMed).

Syndromes

Gastritis, gastric ulcers and gastric carcinomas. Also, may be a cause of bad breath (PubMed).

Normal people can get an erysipelas that is due to Helicobacter (PubMed) but it can be difficult to grow requiring PCR to diagnose.

Treatment

Guidelines (PubMed).

Sequential therapy may be superior in treatment naive patients in one meta-analysis (PubMed). Because of increasing resistance (widespread use of amoxicillin and clarithromycin is driving this phenomena and probably accounts for increasing treatment failure rates), the following regimen MAY be preferred (PubMed):

10-day sequential regimen of ppi, 1 g of amoxicillin, each bid for the first 5 days, THEN ppi, 500 mg of clarithromycin, and 500 mg of tinidazole (metronidazolein the US), all BID for the remaining 5 days.

-OR-

ppi 40 mg qd PLUS clarithromycin 500 mg tid x 2 wks, then ppi qd x 2 wks.

-OR-

Ranitidine bismuth citrate 400 mg bid AND clarithromycin 500 mg tid x 2 wks, then Ranitidine bismuth citrate 400 mg bid x 2 wks.

-OR-

Bismuth subsalicylate (Pepto Bismol®) 525 mg qd AND metronidazole 250 mg qd PLUS tetracycline 500 mg qd* x 2 wks PLUS H2 receptor antagonist therapy x 4 wks

-OR-

ppi PLUS amoxicillin 1 g bid PLUS clarithromycin 500 mg tid x 10 days. -OR- ppi PLUS amoxicillin 1 g tid x 2 wks.

-OR-

Ranitidine bismuth citrate 400 mg bid PLUS clarithromycin 500 mg bid x 2 wks, then Ranitidine bismuth citrate 400 mg bid x 2 wks.

-OR-

ppi 20 mg bid PLUS clarithromycin 500 mg bid PLUS amoxicillin 1 g bid x 10 days.

-OR-

ppi 30 mg bid PLUS clarithromycin 500 mg bid PLUS amoxicillin 1 g bid x 10 days.

*Although not FDA approved, amoxicillin has been substituted for tetracycline in patients for whom tetracycline is not recommended (CDC).

Notes

Treatment also reduces the risk of gastric cancer (PubMed).

The prolific use of macrolides for other reasons is, not surprisingly, leading to H. pylori resistance (PubMed). As the old saying goes: "Use it and lose it."

It pains me to mention this, but adding to standard therapy 100 mg of bovine lactoferrin PLUS the probiotic Probinol-Cadigroup 5 gm qd increased the cure rate to 92% (PubMed).

The treatment of H. pylori may result in the resolution of chronic bad breath (PubMed).

Now you may not think this is cool, but genetic testing shows helicobacter came out of Africa with humans 58,000 years ago (PubMed). And you think cardiology is neat. Ha.

And having Helicobacter may be protective for Shigella and other infectious diarrhea (PubMed).