CLINICAL MANAGEMENT, NURSING ASSESSMENT, AND EVIDENCE-BASED CARE IN THE TREATMENT OF HELICOBACTER PYLORI INFECTION-AN UPDATED REVIEW

Nader Saad Awad Al-Mutairi*, Mashan Mashal Hubaylis Alharthi, Shaie Saleh, Hzam Alkorbi Zid Aldossri, Mohammad Naseer Ali Alqahtani, Faisal Zabin Hashar Alotaibi

ABSTRACT

Background: Helicobacter pylori infection remains one of the most prevalent chronic bacterial infections worldwide and is a major etiological factor in chronic gastritis, peptic ulcer disease, mucosa-associated lymphoid tissue lymphoma, and gastric cancer. Increasing antimicrobial resistance has significantly reduced the effectiveness of conventional eradication regimens, necessitating the development of evidence-based treatment strategies that optimize therapeutic outcomes while minimizing treatment failure. Aim: This review aimed to summarize recent evidence regarding the efficacy, safety, and clinical application of current Helicobacter pylori eradication therapies, with particular emphasis on first-line, second-line, rescue, and adjunctive treatment approaches. Methods: A narrative review of contemporary clinical studies randomized controlled trials, systematic reviews, meta-analyses, and international consensus guidelines was conducted. Evidence related to triple therapy, nonbismuth and bismuth-based quadruple therapies, fluoroquinolone-containing regimens, antimicrobial resistance, acid suppression, probiotic supplementation, recurrence, and rescue treatment strategies was critically synthesized. Results: Conventional clarithromycin-based triple therapy demonstrated variable eradication rates ranging from 49% to 100%, whereas nonbismuth concomitant and sequential therapies generally achieved eradication rates exceeding 88%. Bismuth-containing regimens and levofloxacin-based therapies showed favorable efficacy as second-line and rescue treatments. Antimicrobial resistance, particularly to clarithromycin, metronidazole, and levofloxacin, emerged as the principal determinant of treatment failure. Conclusion: Contemporary management of Helicobacter pylori infection requires individualized, evidence-based treatment guided by regional antimicrobial resistance patterns and previous antibiotic exposure. Optimized multidrug regimens, appropriate acid suppression, and susceptibility-guided rescue therapy remain essential for maximizing eradication success and reducing disease-related complications.

Keywords: Helicobacter pylori; eradication therapy; triple therapy; quadruple therapy; antimicrobial resistance; proton pump inhibitors; probiotics; fluoroquinolones; bismuth therapy; evidence-based care.