Resistance to amoxicillin, tetracycline, and rifabutin was close to nil. In Asia, resistance rates are even higher, as evidenced by studies published from China and Korea. In China, resistance rates to clarithromycin, metronidazole, levofloxacin,

amoxicillin, gentamicin, and furazolidone were 21.5, 95.4, 20.6, 0.1, 0.1, and 0.1%, respectively, with more than 25% of patients having resistance to more than one antibiotic [65]. In Korea, the primary resistance rate for amoxicillin was 14.9%, clarithromycin resistance occurred in 23.7%, and levofloxacin resistance was 28.1%, all of which had significantly increased since 2003 [66]. In Africa, a study from Senegal showed no resistance to amoxicillin or tetracycline, very low resistance to clarithromycin (1%), but considerable metronidazole resistance (85%) [67]. A pilot study on the H2 receptor antagonist latifudine showed that it can achieve similar eradication rates Obeticholic Acid ic50 to regimes based on PPIs at a significantly reduced cost [68]. Although twice daily dosing of PPI is the standard

of care for H. pylori eradication, one study from Taiwan looked at single dose esomeprazole vs pantoprazole and found superior eradication rates for the former [69]. A high-quality meta-analysis showed higher eradication rates for both esomeprazole (82.3%) and rabeprazole (80.5%) than for first-generation PPIs (76.2–77.6%) [70]. The use of probiotics as adjuvant therapies in H. pylori eradication in recent years has been a topic of considerable interest. This last year has been especially prolific, albeit Talazoparib clinical trial with notable divergent results. The most promising probiotic appears to be Lactobacillus species, and the most significant studies focused on the use of this agent. One Chinese study showed significantly improved eradication rates when twice daily L. acidophilus was used alongside standard triple therapy (81.6 vs 61.5%) [71]. Terminal deoxynucleotidyl transferase A

randomized double-blinded, placebo-controlled trial in Iranian children disclosed a positive effect of a mixture probiotic, mainly Lactobacillus sp. added to PPI, amoxicillin, and furazolidone on eradication rates (90 vs 69%) [72]. An Italian study found L. reuteri supplementation to improve both eradication rates and side-effect profile when used as part of a second-line levofloxacin-based regimen [73]. Nonetheless, two recent studies from Iran [74, 75], involving standard triple and bismuth therapy and other three studies from Italy [76-78] dealing with triple and sequential therapy (two of them in children [74, 76]), could not show eradication benefit from probiotic use, albeit it usually reduced antibiotic-related adverse events (especially diarrhea and nausea), thus improving compliance. A double-blind, placebo-controlled trial from Brazil could not show either increased efficacy nor decreased side effects after the addition of a probiotic to a triple therapy containing lansoprazole, tetracycline, and furazolidone [79].