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Treatment regimens for Helicobacter pylori

Author
Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
Section Editor
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Shilpa Grover, MD, MPH, AGAF

INTRODUCTION

Multiple antibiotic regimens have been evaluated for Helicobacter pylori therapy [1-5]. However, few regimens have consistently achieved high eradication rates. There are also limited data on H. pylori antibiotic resistance rates to guide therapy. The treatment regimen that is selected must consider local antibiotic resistance patterns (if known), previous exposure and allergies to specific antibiotics, cost, side effects, and ease of administration.

This topic will review treatment regimens for H. pylori. The bacteriology, epidemiology, and diagnostic tests for H. pylori infection are discussed elsewhere. (See "Indications and diagnostic tests for Helicobacter pylori infection" and "Bacteriology and epidemiology of Helicobacter pylori infection".)

INDICATIONS FOR TREATMENT

All patients with evidence of active infection with H. pylori should be offered treatment. Indications for testing for H. pylori infection are discussed in detail separately. (See "Indications and diagnostic tests for Helicobacter pylori infection", section on 'Indications for testing'.)

INITIAL ANTIBIOTIC THERAPY

Approach to selecting an antibiotic regimen — The choice of initial antibiotic regimen to treat H. pylori should be guided by the presence of risk factors for macrolide resistance and the presence of a penicillin allergy [6]. In patients with risk factors for macrolide resistance, clarithromycin-based therapy should be avoided. A suggested approach to the selection of antibiotics for initial treatment of H. pylori infection is outlined in the algorithm (algorithm 1 and table 1). (See 'Clarithromycin-based therapy' below.)

Risk factors for macrolide resistance include:

                       
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Literature review current through: Sep 2017. | This topic last updated: Jul 26, 2017.
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