Non-antibiotic Agents in the Treatment of H. pylori Infection
from: Helicobacter pylori (Edited by: Lyudmila Boyanova). Caister Academic Press, U.K. (2011)
As standard regimens for the eradication of H. pylori infection often fail owing to antibiotic resistance or low patient compliance, there is an increasing need for new drugs such as non-antibiotic agents (NAAs) or optimised treatment regimens. Anti-H. pylori activity has been detected in vitro by many NAAs such as lactobacilli, Saccharomyces boulardii, lactoferrin, green tea, garlic, propolis, broccoli, resveratrol, plant oils etc. Many NAAs have been active against both antibiotic susceptible and resistant H. pylori strains. So far, cell line, animal or clinical trials have shown H. pylori eradication, although often low, using NAAs alone e.g., black caraway, garlic, green tea, turmeric, broccoli and mastic gum. Combinations of standard regimens with NAAs such as lactobacilli, S. boulardii, turmeric, Korea red ginseng, N-acetylcysteine and vitamin C have improved the eradication often by >10% and most of them have reduced the side effects of the regimens. Advantages of some NAAs are their anti-adhesive, anti-urease, anti-inflammatory and anti-tumour effects and bactericidal activity on H. pylori. Moreover, anti-adhesive NAAs can prevent H. pylori colonisation or reinfection. In addition, aspirin, monoclonal antibodies, redox protein inhibitors and synthetic antimicrobial peptidomimetics have been evaluated as applicants for therapeutic intervention. Synergy between NAAs is a very attractive topic, which should be evaluated, however, with caution. To choose an agent, it is necessary to consider the source, safety or toxicity, dose-depending deleterious effects and allergenicity of some NAAs as well as their quality control and evidence-based trials. At present, we await further studies, especially clinical trials, to suggest the choice, dosage, start time and duration of administration aiming at the routine use of the NAAs. In conclusion, NAAs probably carry greater than the expected potential for prophylaxis or adjuvant therapy of H. pylori infection and can help to control the rising bacterial resistance to antibiotics read more ...