Treatment options for Helicobacter pylori infection in the elderly

Helicobacter pylori infection plays a key role in dyspepsia, peptic ulcer disease and gastric cancer, thus the eradication of the infection has become an important treatment goal in clinical practice. The aim of this review is to present indications and therapies that are relevant for the management of H. pylori infection in elderly patients. Effective antimicrobial therapy is available, although there is still no ideal treatment, and indications for therapy continue to evolve. One-week proton pump inhibitor-based triple therapies are very effective in elderly patients; moreover, low doses of antibiotics (clarithromycin) and proton pump inhibitors are probably sufficient to obtain excellent cure rates, reducing side effects and improving compliance in elderly subjects. In some elderly patients, 10-day sequential treatment may be considered. Prolonging triple therapies to 10-14 days or using bismuth-based quadruple therapies require further studies in elderly patients. Low compliance and antibiotic resistance are the main factors related to treatment failure in old age. Therapy for treatment failure may be improved by assessing antimicrobial sensitivity. New drugs and forms of administration have been reported, although their efficacy requires confirmation. © 2006 Future Medicine Ltd.