ACG : H. Pylori Infection Treatment Recommendations
Helicobacter pylori (H. pylori) infection is an important cause of peptic ulcer disease and gastric cancer and is prevalent worldwide. 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. The Guidelines have been published in American Journal of Gastroenterology.
| FIRST-LINE THERAPIES | ||||||||||||||||||||||
|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
| Regimen | Drugs/Dosing | Duration (days) | ||||||||||||||||||||
| RECOMMENDED | ||||||||||||||||||||||
Clarithromycin triple | PPI (standard or double dose twice daily) + clarithromycin (500mg twice daily) +amoxicillin (1g twice daily) or metronidazole (500mg three times daily) | 14 | ||||||||||||||||||||
Bismuth quadruple | PPI (standard dose twice daily) + bismuth subcitrate (120–300mg 4 times daily) or subsalicylate (300mg 4 times daily) + tetracycline (500mg 4 times daily) +metronidazole (250mg 4 times daily or 500mg 3–4 times daily) | 10 –14 | ||||||||||||||||||||
Concomitant | PPI (standard dose twice daily) + clarithromycin (500mg twice daily) + amoxicillin (1g twice daily) + nitroimidazole (500mg twice daily) | 10 –14 | ||||||||||||||||||||
| SUGGESTED | ||||||||||||||||||||||
Sequential | PPI (standard dose twice daily) + amoxicillin (1g twice daily) followed by | 5 –7 | ||||||||||||||||||||
PPI + clarithromycin (500mg twice daily) + nitroimidazole (500mg twice daily) | 5 –7 | |||||||||||||||||||||
Hybrid | PPI (standard dose twice daily) + amoxicillin (1g twice daily) followed by | 7 | ||||||||||||||||||||
PPI + amoxicillin + clarithromycin (500mg twice daily) + nitroimidazole | 7 | |||||||||||||||||||||
Levofloxacin triple | PPI (standard dose twice daily) + levofloxacin (500mg daily) + amoxicillin | 10 –14 | ||||||||||||||||||||
Levofloxacin sequential | PPI (standard or double dose twice daily) + amoxicillin (1g twice daily) followed by | 5 –7 | ||||||||||||||||||||
PPI + levofloxacin (500mg daily) + nitroimidazole (500mg twice daily) | 5 –7 | |||||||||||||||||||||
LOAD | Levofloxacin (250mg daily) + omeprazole (double dose daily) + (Alnia)nitazoxanide (500mg twice daily) + doxycycline (100mg daily) | 7 –10 | ||||||||||||||||||||
References :
The American Journal of Gastroenterology volume112, pages212–239 (2017) doi:10.1038/ajg.2016.563
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