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JOURNAL ARTICLE

ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

William D Chey, Grigorios I Leontiadis, Colin W Howden, Steven F Moss
American Journal of Gastroenterology 2017, 112 (2): 212-239
28071659
Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For first-line treatment, clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When first-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a first-line treatment containing clarithromycin, bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options. If a patient received first-line bismuth quadruple therapy, clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested first-line and salvage regimens can be found in the guideline.

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Joseph Etienne

Where can we send gastric specimen to check for H pylori bacterial culture + sensitivity in the continental USA?

2

omar jarrar

Most patient in saudi Arabia failed to be eradicated by clarithromycin or metronidazole based triple therapy
Even the success rate with levofloxacin
is low not more than 50 percent
I donot have study but in my patients only one succass every two eradicate
Iam in dilemma because or resistance
What to do?

2

Dennis Kordie

Thanks!

0

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