Infectious Disease Compendium

Helicobacter

Microbiology

Microaerophilic curved gram negative rods. There are several dozen spp.

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).

For H. pylori, urea breath testing or stool antigen testing are the tests of choice, not serology. Test familiy members of gastic cancer patients.

Normal people can get an erysipelas that is due to Helicobacter but it can be difficult to grow requiring PCR to diagnose. Often H. cinaedi, can cause bacteremia and cellulitis. Blood cultures take 6–12 days to become positive (PubMed).

Non pylori species can cause the occasional bacteremia and other diseases.

Treatment

Guidelines (PubMed). I have actually never treated this disease.

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):

From the guidelines

  • Patients should be asked about any previous antibiotic exposure(s) and this information should be taken into consideration when choosing an H. pylori treatment regimen.
  • Clarithromycin triple therapy consisting of a PPI, clarithromycin, and amoxicillin or metronidazole for 14 days remains a recommended treatment option in regions where H. pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure for any reason).
  • Bismuth quadruple therapy consisting of a PPI, bismuth, tetracycline, and a nitroimidazole for 10–14 days is a recommended first-line treatment option. Bismuth quadruple therapy is particularly attractive in patients with any previous macrolide exposure or who are allergic to penicillin.
  • Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days is a recommended first-line treatment option.
  • Sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, clarithromycin, and a nitroimidazole for 5–7 days is a suggested first-line treatment option .
  • Hybrid therapy consisting of a PPI and amoxicillin for 7 days followed by a PPI, amoxicillin, clarithromycin and a nitroimidazole for 7 days is a suggested first-line treatment option.
  • Levofloxacin triple therapy consisting of a PPI, levofloxacin, and amoxicillin for 10–14 days is a suggested first-line treatment option .
  • Fluoroquinolone sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, fluoroquinolone, and nitroimidazole for 5–7 days is a suggested first-line treatment option.

    *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) (PubMed) and perhaps coronary artery disease (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).

Last Update: 04/02/18.

Last update: 05/05/18