Quadruple therapies show a higher eradication rate compared to standard triple therapy for Helicobacter pylori infection within the LEGACy consortium. A multicenter observational study in European and Latin American countries.

INTRODUCTION: Gastric cancer (GC) is one of the most lethal malignancies worldwide. Helicobacter pylori is the primary cause of GC; therefore, its eradication reduces the risk of developing this neoplasia. There is extensive evidence regarding quadruple therapy with relevance to the European population. However, in Latin America, data are scarce. Furthermore, there is limited information about the eradication rates achieved by antibiotic schemes in European and Latin American populations. OBJECTIVE: To compare the effectiveness of standard triple therapy (STT), quadruple concomitant therapy (QCT), and bismuth quadruple therapy (QBT) in six centers in Europe and Latin America. METHODS: A retrospective study was carried out based on the LEGACy registry from 2017 to 2022. Data from adult patients recruited in Portugal, Spain, Chile, Mexico, and Paraguay with confirmed H. pylori infection who received eradication therapy and confirmatory tests at least 1 month apart were included. Treatment success by each scheme was compared using a mixed multilevel Poisson regression, adjusting for patient sex and age, together with country-specific variables, including prevalence of H. pylori antibiotic resistance (clarithromycin, metronidazole, and amoxicillin), and CYP2C19 polymorphisms. RESULTS: 772 patients were incorporated (64.64% females; mean age of 52.93 years). The total H. pylori eradication rates were 75.20% (255/339) with STT, 88.70% (159/178) with QCT, and 91.30% (191/209) with QBT. Both quadruple therapies (QCT-QBT) showed significantly higher eradication rates compared with STT, with an adjusted incidence risk ratio (IRR) of 1.25 (p: <0.05); and 1.24 (p: <0.05), respectively. The antibiotic-resistance prevalence by country, but not the prevalence of CYP2C19 polymorphism, showed a statistically significant impact on eradication success. CONCLUSIONS: Both QCT and QBT are superior to STT for H. pylori eradication when adjusted for country-specific antibiotic resistance and CYP2C19 polymorphism in a sample of individuals residing in five countries within two continents.

Etiopathogenic theories about long COVID.

The main etiopathogenic theories of long coronavirus disease (COVID) are listed and a conjunction of them is carried out with the objective of deciphering the pathophysiology of the entity, finally the main lines of treatment existing in real life are discussed (Paxlovid, use of antibiotics in dysbiosis, triple anticoagulant therapy, temelimab).

Catastrophic antiphospholipid syndrome in Mexico. Literature review.

Catastrophic antiphospholipid syndrome (CAPS) is a rare entity, approximately 600 cases have been reported around the world, and the prevalence in Mexico is unknown. OBJECTIVE: To determine the estimated prevalence of CAPS in Mexico. MATERIAL AND METHODS: A literature search of isolated clinical cases or case series was conducted in diverse search engines, using the terms: "Catastrophic Antiphospholipid Syndrome" and "Mexico" in May 2022. RESULTS: We found a series of retrospective cases in autopsies that included 12 cases, two reports that included 2 cases each, and reports of 11 isolated clinical cases; these publications were generated between 2003 and 2020. In total, we collected data on 27 cases of CAPS, of which 16 correspond to primary antiphospholipid syndrome, 10 are associated with systemic lupus erythematosus, and 1 case corresponds to systemic sclerosis. The estimated prevalence rate in the Mexican population in 2022 is 2 cases per 10,000,000 inhabitants. The estimated mortality was 68% in this case series. CONCLUSION: Cases of catastrophic antiphospholipid syndrome in Mexico are underreported; identifying them will help improve current diagnostic and therapeutic strategies used in the country, encouraging the implementation of triple therapy and, in refractory cases, the use of eculizumab, to reduce current mortality.

Recomendaciones en el manejo y tratamiento del asma en la Argentina (REMA). Consenso Delphi modificado RAND/UCLA de la Asociación Argentina de Alergia e Inmunología Clínica y Asociación Argentina de Medicina Respiratoria / Recommendations for the Management and Treatment of Asthma in Argentina (RE.M.A). A RAND/UCLA modified Delphi Consensus Argentinian Association of Allergy and Clinical Immunology and Argentinian Association of Respiratory Medicine

El asma es una enfermedad crónica de la vía aérea prevalente en nuestro país, con frecuente mal control. Algunos especialistas de la Asociación de Alergia e Inmunología Clínica y la Asociación Argentina de Medicina Respiratoria han realizado recomendaciones sobre el manejo y tratamiento del asma mediante la metodología de consenso RAND/UCLA Delphi modificada sobre la base de la evidencia científica (GRADE). Este documento provee recomendaciones basadas en la opinión de especialistas y fundamentada en evidencia científica seleccionada en cuanto a la importancia de mejorar la adherencia al tratamiento y seguimiento a través de diferentes estrategias. Así mismo, provee recomendaciones actualizadas en aspectos críticos del tratamiento del asma leve al grave. Se recomienda, para mejorar la adherencia, el uso de planes personalizados de manejo (1 °C), uso de herramientas a través de teléfonos móviles (1B) y educación (1 °C). Con respecto a la inmunoterapia sublingual solo debe ser indicada a pacientes con asociación con rinitis alérgica, asociada a ácaros y síntomas de asma a pesar del tratamiento adecuado con FEV1 > 70 % (1B). Se recomienda fuertemente en el asma leve (escalón 2 GINA) el uso de broncodilatadores de acción rápida asociados a corticoides inhalados a demanda (1A). En asma grave, se recomienda el uso de la triple terapia inhalada con anticolinérgicos de acción prolongada, beta 2 de acción prolongada y corticoides inhaladas (1B). El uso de biológicos en asma grave está fuertemente indicado en fenotipo T2 con dupilumab (1A), T2 alérgico con omalizumab (1A) y en el T2 eosinofílico con benralizumab, o mepolizumab, con sus características distintivas (1A).

Asthma is a common chronic airway disease in our country, although with high poor control. Some specialists of the Asociación de Alergia e Inmunología Clínica and Asociación Argentina de Medicina Respiratoria have made recommendations for management and treatment of asthma, using a RAND/UCLA modified Delphi consensus methodology, based on GRADE evidence. This document provides recommendations based on specialist opinions about different strategies to improve adherence. Besides, it provides recommendations about critical issues of mild to severe asthma treatment. It´s recommended to improve adherence, personalized control-based management plan (1 °C), mobile devices (1B) and education (1 °C). Sublingual immunotherapy must be prescribed only in patients with allergic rhinitis, mite associated, and persistent symptoms although appropriate treatment with FEV1 > 70 % (1B). Use of fast action bronchodilators associated with inhaled corticosteroids prn in mild asthma (GINA stage 2) has strong recommendation (1A). Use of triple inhaled therapy (long acting anticholinergics, long acting beta 2 agonists and inhaled corticosteroids) is recommended in severe asthma (1B). Biologics has strong recommendations severe asthma: in phenotype T2 with dupilumab (1A), in phenotype allergic T2 with omalizumab (1A) and phenotype eosinophilic T2 with benralizumab or mepolizumab with distinctive characteristic (1A).

Cost-effectiveness analysis: fluticasone furoate/umeclidinium/vilanterol for the treatment of moderate to severe chronic obstructive pulmonary disease from the perspective of the Chilean public health system.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is an inflammatory lung disease characterized by long-term breathing problems and airflow limitations. International guidelines recommend using bronchodilators like long-acting beta- and muscarinic antagonists, and inhalational corticosteroids. OBJECTIVES: The cost-effectiveness of single-inhaler triple therapy containing fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) was compared to the treatments Fluticasone Furoate/Vilanterol (FF/VI), Umeclidinio/Vilanterol (UMEC/VI) and Fluticasone Propionate 250 mcg/Salmeterol 25mcg + Tiotropio 18 mcg (FP/SAL/TIO) for patients with COPD from the Chilean public health system perspective. METHODS: A cost-effectiveness analysis was performed, including a deterministic and probabilistic sensitivity analysis over a 25-year time horizon. Two scenarios were assessed to study the effect of a 3%-discount for costs and outcomes on FF/UMEC/VI. RESULTS: The incremental cost-effectiveness (ICER) of FF/UMEC/VI versus FF/VI was $10,076/QALY, being a cost-effective alternative to a threshold of one Gross Domestic Product per capita (GDPpc), while versus FP/SAL/TIO the ICER increased to $50,288/QALY, showing to be a non-cost effective alternative to 1 GDPpc, but at a threshold of 3 GDPpc. CONCLUSION: FF/UMEC/VI appears to be a cost-effective intervention for treating COPD compared to FF/VI. However, FF/UMEC/VI compared to FP/SAL/TIO showed an ICER above the threshold of 1 GDPpc, but, in comparison with lower price, the ICER was below 3 GDPpc.

Pharmacological therapy used in the elimination of Helicobacter pylori infection: a review.

The optimal therapy for Helicobacter pylori (H. pylori) infection should combine a high cure rate and a short treatment duration with a favorable side-effect profile and should maintain a low cost. Several strategies have been proposed to increase the H. pylori eradication rate, including the extension of the treatment duration to 14 d, the use of a four-drug regimen (quadruple, sequential, and concomitant treatments), and the use of novel antibiotics, such as levofloxacin. However, triple therapy remains the most widely accepted first-line treatment regimen in Brazil and the United States and throughout Europe. Because this therapy is limited by resistance to clarithromycin, other therapeutic regimens have been investigated worldwide. This review describes the current literature involving studies directly comparing these different therapies and their efficacies.

Impacto de la triple terapia aplicada a pacientes con úlcera gastroduodenal / Impact of triple therapy on patients with peptic ulcer

Se realizó un estudio de intervención terapéutica en 57 pacientes a quienes se les diagnosticó úlcera péptica gastroduodenal en el Servicio de Endoscopia del Hospital General Docente "Dr. Juan Bruno Zayas Alfonso" de Santiago de Cuba, de septiembre del 2009 a igual mes del 2010, con vistas a evaluar el impacto de la triple terapia establecida para esta afección. En la serie se observó una mayor incidencia de la úlcera gastroduodenal en el grupo etario de 36-45 años, así como un predominio del sexo masculino, con un tiempo de evolución de la enfermedad que superó los 12 meses. Igualmente, los afectados presentaron epigastralgia como el síntoma más frecuente, y la gastritis antral eritematosa y la úlcera duodenal como afecciones más comunes, con una elevada positividad de Helicobacter pylori y una reacción favorable luego de aplicado el tratamiento para erradicarlo.

A therapeutic intervention study was conducted in 57 patients who were diagnosed with peptic ulcer at the Endoscopy Department of "Dr. Juan Bruno Zayas Alfonso" Teaching General Hospital of Santiago de Cuba, from September 2009 to the same month of 2010, in order to assess the impact of the triple therapy on this condition. In the series a higher incidence of the peptic ulcer was observed in the group aged 36-45 years, as well as a prevalence of the male sex, with a time of disease progression that exceeded 12 months. Likewise, patients presented with epigastralgia as the most frequent symptom, and erythematous antral gastritis and duodenal ulcer as the most common conditions, with high Helicobacter pylori positivity and a favorable reaction after applying the treatment to eliminate it.

Hígado y hepatitis C en los adultos mayores: Opciones de tratamiento / Liver and hepatitis C in older adults: Treament options

Los pacientes ancianos con hepatitis crónica por virus C sin evidencia de cirrosis en general se manejan expectante, sin el tratamiento combinado establecido de interferones pegilados alfa y ribavirina, ya que es poco probable que la vida se vea comprometida por su enfermedad hepática. Además, frecuentemente presentan co-morbilidad que puede afectar su sobrevida antes de que se presente descompensación hepática. El tratamiento en la población de adultos mayores, permanece como un asunto controversial, con evidencias limitadas. Las recomendaciones para el tratamiento de la población general están basadas sobre estudios multicéntricos, controlados y randomizados. Se ha evaluado el efecto de la edad sobre el tratamiento de pacientes con hepatitis crónica C con interferón pegilado alfa más ribavirina, se encontró que los pacientes mayores de 40 años, tuvieron menor oportunidad de observar respuesta virológica sostenida, comparado con pacientes más jóvenes. Los pacientes entre las edades 40-49, 50-64, y mayores de 65 años, demostraron bajas tasas de respuesta virológica sostenida. Todavía no está claro si la eficacia del interferón pegilado alfa y la ribavirina en pacientes con VHC mayores de 65 años, es la misma o peor que para pacientes en el grupo de 40 a 65 años. En los pacientes mayores de 65 años todavía no hay acuerdo sobre el tratamiento con la terapia doble o triple.

Elderly patients with chronic hepatitis virus C without evidence of cirrhosis in general handled is expectant, without established interferons pegylated alpha and ribavirin combination treatment, since it is unlikely that life is compromised by their liver disease. In addition, they frequently present co-morbidities which may affect their survival until present hepatic decompensation. Treatment in the older adult population, remains a controversial topic, with limited evidence. Recommendations for the treatment of the general population are based on large studies multicenter, controlled, randomized. He has been evaluated the effect of age on the treatment of patients with chronic hepatitis C with pegylated alpha interferon plus ribavirin, it was found that patients older than 40 years, had opportunity to observe virologic response sustained, compared to younger patients. Patients ages 40-49, 50-64, and 65 years and older, showed low rates of sustained virologic response. It is not yet clear whether the efficacy of pegylated alpha interferon and ribavirin in patients with HCV over 65 years old, is the same or worse for patients in the Group of 40 to 65 years. In patients older than 65 years still no agreement about treatment with double or triple therapy.

Eficacia de la triple cura y su relación con el genotipo de Helicobacter pylori: pacientes con dispepsia de la region centroccidental de Venezuela / Pharmacological triple therapy`s efficacy and it`s association with Helicobacter pylori`s genotype: patients suffering from dyspepsia on Venezuela`s central western region

Introducción: El Helicobacter pylori es una bacteria reconocida como agente causal de gastritis crónica, además de asociarse al desarrollo de úlcera gástrica, duodenal y está relacionada con el desarrollo de cáncer gástrico. Materiales y métodos: Se realizó un estudio de tipo experimental, incluyendo a los pacientes que acudieron a la consulta de Gastroenterología del Hospital "Dr. Antonio María Pineda" Barquisimeto en los meses de juniooctubre de 2009 presentando dispepsia, criterios de inclusión y exclusión; se les practicó endoscopia digestiva superior con biopsia de mucosa gástrica para test de ureasa rápida, estudio histológico y determinación de los genotipos de cagA y vacA H. pylori por Reacción en Cadena de la Polimerasa (PCR). Al confirmar la infección por la bacteria se indicó tratamiento con amoxicilina, claritromicina y pantoprazol durante 14 días consecutivos. A las 8 semanas de culminada la medicación, se practicó el segundo estudio endoscópico superior con toma de biopsias para test de ureasa rápida y estudio anatomopatológico. Resultados: Un total de 60 pacientes fueron incluidos, 76,7% mujeres y 23,3% hombres, edad promedio 38,3 años. La prevalencia de infección por H. pylori fue de 98,3% por test de ureasa y 86,67% por histología, el síntoma más frecuente asociado antes, durante y posterior a la medicación con triple cura fue la epigastralgía. Hubo un predominio de los genotipos cagA en 84,5% y las formas alélicas s1/m1 55,2%. El 56,3% de los pacientes que presentaban genotipo vacA s1/m1 respondió al tratamiento. Un 56,7% de los pacientes no respondió a la terapia triple, el 66,7% contaba con la forma alélica s2/m2 del vacA y 57,1% presentaba el genotipo cagA-positivo. Conclusión: La triple cura resulto ineficaz en el tratamiento para la infección por Helicobacter pylori en la población estudiada y presentar la forma alélica vacA s1/m1 es estadísticamente significativo para responder a esta terapia farmacológica...

Introduction: Helicobacter pylori is a bacteria known as causal agent of chronic gastritis, as well as being associated to the development of gastric and duodenal ulcer and related to the development of gastric cancer. Goal: to establish the triple therapy based pharmacological treatment efficacy on patients with dyspepsia and proved H. pylori infection. Materials and methods: It was done an experimental type study, including patients that underwent evaluation on "Dr. Antonio Maria Pineda" University Hospital´s gastroenterology service, in Barquisimeto, between June – October 2009, who presented dyspepsia and fulfilled the inclusion exclusion criteria, they underwent a superior digestive endoscopy with gastric mucous membrane biopsy for fast urease test, histologic evaluation, and polymerase chain reaction (PCR) test aid establishment of cagA and vacA H. pylori genotype. When H. pylori infection was confirmed, a 14 continuous days amoxicillin, clarithromycin and pantoprazole based treatment was prescribed. 8 weeks later the ending of the pharmacological treatment a second superior digestive endoscopy including rapid urease test and histopathological assessment biopsy was performed. Results: 60 patients were included, 76,7% women and 23,4% men, average age 38,3 years old. The H. pylori’s prevalence were 98,3% by rapid urease test and 86,67 by histological assess, the most frequent related symptom before, through an after pharmacological triple therapy was epigastric pain. There was cagA genotype and s1/m1 allelic form predominance by 84, 5% and 55,2% respectively. 56,3% of vacA s1/m1 patients had a positive response to treatment. Triple therapy failed on 56,7% of patients, of them, 66,7% had the s2/m2 vacA´s allelic form and 57,1% had cagA genotype...

Comparación de la terapia secuencial con la triple terapia estándar en la erradicación de Helicobacter pylori / Comparison of sequential therapy for eradication of Helicobacter pylori with standard triple therapy

Introducción: El Helicobacter pylori es un agente involucrado en gran cantidad de patologías; se han establecido terapias de primera línea para lograr altas tasas de erradicación, pero en años recientes han perdido eficacia por lo cual han aparecido nuevas terapias como la secuencial. Este estudio busca comparar las tasas de erradicación y los efectos colaterales de la terapia secuencial (TS) vs. la terapia triple estándar (TTE). Métodos: Estudio prospectivo, aleatorizado, en pacientes del Hospital El Tunal, realizado entre noviembre del 2008 y septiembre del 2010. Se incluyeron pacientes con dispepsia funcional o úlceras pépticas con edades entre 19 y 70 años que hayan sido remitidos a endoscopia digestiva alta por síntomas dispépticos, que no hayan recibido tratamientos previos de erradicación de H. pylori dentro de los tres meses anteriores, como tampoco durante el mes anterior medicamentos antisecretores, bismuto o antibióticos. Los cálculos estadísticos se realizaron con el programa SPSSSrv 10. Resultados: Al finalizar el estudio se incluyeron 165 pacientes, 85 en el grupo de TTE y 80 en el grupo de TS. En el grupo A (TTE), completaron el tratamiento 60 de 80 (75%) y en estos la infección fue erradicada en 51, dando una eficacia por protocolo de 85% (IC 95%: 73-92) y por intención de tratar de 63,75% (IC 95% 52-74). En el grupo de TS completaron el tratamiento 70 pacientes de 85 (82%) y en estos la infección fue erradicada en 53, dando una eficacia por protocolo de 75% (IC 95% 63-85) y por intención de tratar de 62% (IC 95%: 51-72). Conclusiones: En el presente estudio, se encontró una baja tasa de éxito tanto con la TTE como con la TS, utilizando medicamentos genéricos, en una población de Bogotá. Consideramos necesario realizar estudios similares usando medicamentos originales e investigar la resistencia a los antimicrobianos en la población de estudio, como se está preconizando en la actualidad.

Introduction: Helicobacter pylori are involved in a large number of pathologies. Although first line therapies were developed to achieve high eradication rates, in recent years they have lost effectiveness. This has lead to the use of new therapies such as sequential therapy. This study compares eradication rates and collateral effects of sequential therapy (ST) and standard triple therapy (STT). Methods: This is a prospective randomized study of patients at El Tunal Hospital performed between November 2008 and September 2010. The study included patients with functional dyspepsia or peptic ulcers between 19 and 70 years of age who had undergone high digestive endoscopy for dyspeptic symptoms. Patients had not received H. Pylori eradication treatments for at least three months prior to endoscopies nor had they received antisecretory medications, bismuth or antibiotics during the previous month. Statistical calculations were done with SPSS. Results: At the end of the study 165 patients were included: 85 in the STT group (Group A) and 80 in the ST group (Group B). In group A 60 out of 80 patients (75 %) completed the treatment, but the infection was eradicated in only 51 patients for an 85% efficacy rate according to the protocol (95% CI: 73-92) and 63.75 % according to intention to treat (95% CI: 52-74). In Group B 70 out of 85 patients (82 %) completed the treatment, but the infection was eradicated in only 53 patients for a 75% efficacy rate according to the protocol (95% CI: 63-85) and 62% according to intention to treat (95% CI: 51-72). Conclusions: This study found low success rates with both STT and TS using generic medications in a population in Bogota. We consider it necessary to conduct similar studies using original medications and to conduct research about resistance to currently recommended antimicrobials in this population.

Eficacia de la terapia secuencial en el tratamiento de la infección por Helicobacter pylori / Efficacy of sequential therapy in the treatment of Helicobacter pylori infection

Introducción: La infección por Helicobacter Pylori (H. pylori) es un problema de salud pública a nivel mundial, por lo que la pobre respuesta a la terapéutica convencional utilizada Terapia Triple (TT), expresadas en bajas tasas de erradicación de la infección, plantea establecer otras pautas de tratamiento que pueden ser más eficaces como la Terapia Secuencial (TS). Objetivos: Evaluar la efectividad de la TS en la erradicación de la infección por H. pylori, comparada con la TT. Métodos: se evaluaron 68 pacientes entre 18 y 76 años con dispepsia, y se les realizó diagnóstico de infección por H. pylori por biopsia (histología); se les dividió equitativamente en dos grupos y se trataron por primera vez con TS Y TT respectivamente; un mes posterior a tratamiento se les realizó biopsia (histología) y la prueba del aliento de la urea C14 (PYtest). Se aplicó la prueba chi-cuadrado de Pearson. Resultados: La media de la edad fue 41,5 años; con 74,0% de mujeres. Para ambas terapias de tratamiento, 21 pacientes (84%) biopsia (-), y 4 (16%) biopsia (+), no fue estadísticamente significativo. De los 50 pacientes tratados en ambas terapias, 42 (84%) presentan la prueba del aliento urea C14 negativo y 8 (16%) positiva, y fue estadísticamente significativa (p = 0,0001). La presencia de enfermedad, medida en Sensibilidad fue de 75,0%, la curación, expresada en Especificidad tuvo un valor de 95,2%. Conclusiones: Diez días de Terapia Secuencial no fue superior a catorce días de Terapia Triple en pacientes tratados por primera vez.

Introduction: Infection by Helicobacter pylori (H. pylori) is a global public health issue, for which the poor response to the conventional therapeutics using Triple Therapy (TT), expressed by the low rates of eradication of infection, raises the need to establish other treatment regimens that may be more effective, such as Sequential Therapy (ST). Objectives: Evaluate the efficiency of ST in the eradication of infection by H. pylori, as compared to TT. Methods: 68 patients between the ages of 18 and 76 were evaluated with dyspepsia, and were diagnosed for infection by H. pylori through biopsy (histology); they were divided equally in tw o groups and were treated for the first time by ST and TT, respectively; a month after treatment a biopsy (histology) and the 14CUrea Breath Test (PYtest) were performed. Pearson’s chi-square test was performed. Results: the average age was 41.5 years; with 74.0% women. For both treatment therapies, 21 patients (81%) biopsy (-), and 4 (16%) biopsy (+), were not statistically significant. Of the 50 patients treated in both therapies, 42 (84%) were negative for the 14C-Urea Breath Test and 8 (16%) were positive, these results were statistically significant (p = 0.0001). The presence of the disease, measured in sensitivity was 75.0%, and the healing, measured in specificity, had a value of 95.2%. Conclusions: Ten days of Sequential Therapy were not superior to fourteen days of Triple Therapy in patients treated for the first time.

Helicobacter pylori: Tratamiento actual. Un importante reto en gastroenterología / Helicobacter pylori: Current treatment An importanmt challenge for gastroenterology

Desde cuando se descubrió Helicobacter pylori, su erradicación ha constituido uno de los más importantes retos en gastroenterología. En muchas partes se desconocen las prevalencias de resistencia primaria del microorganismo a los diferentes antibióticos que empíricamente utilizan y por no realizar de rutina pruebas para verificar la erradicación, en la práctica diaria, se ignora la efectividad de los esquemas prescritos. Conocer estos dos factores, permite, no solo identificar los que aún persisten infectados, sino también elegir la próxima terapia de rescate de una manera más racional. El no disponer de la información sobre resistencia pretratamiento es un inconveniente que impide evaluar el impacto de la resistencia con el fracaso terapéutico. A nivel mundial, la triple terapia estándar ha perdido la eficacia que tenía en el pasado y la terapia secuencial no es igualmente eficaz en todos los sitios, en especial en regiones en donde existe alta resistencia a claritromicina y metronidazol. Los esquemas con levofloxacina han demostrado eficacia en triples terapias de primera línea o como terapia de rescate, pero es necesario que cada región adopte sus propios esquemas de tratamiento fundamentados en pruebas de susceptibilidad y en estudios farmacogenómicos.

Since when Helicobacter pylori was discovered, the eradication has been one of the most important challenges in gastroenterology. In many places, the prevalence of primary resistance of microorganism to the different antibiotics is not known, and these are used empirically. In daily practice, no routine test is used to verify the eradication, and therefore do not know the effectiveness of the schemes. Knowing these two factors is possible identify those still infected and choose the next rescue therapy in a rational form. The absence of information on pre-treatment resistance is a problem that cannot measure the impact of resistance to therapeutic failure. A global level, the standard triple therapy has lost the effectiveness that it had in the past and sequential therapy is not equally effective everywhere, especially in regions where there is high resistance to clarithromycin and metronidazole. The schemes have proved effective with levofloxacin triple therapies as first line therapy or rescue, but it is necessary that each region takes its own schemes of treatment based on susceptibility tests and pharmacogenomic studies.