Treatment regimens for Helicobacter pylori
- Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
Sheila E Crowe, MD, FRCPC, FACP, FACG, AGAF
- Professor of Medicine
- University of California, San Diego
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 . 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:To continue reading this article, you must log in with your personal, hospital, or group practice subscription. For more information on subscription options, click below on the option that best describes you:
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- INDICATIONS FOR TREATMENT
- INITIAL ANTIBIOTIC THERAPY
- Approach to selecting an antibiotic regimen
- - Patients with risk factors for macrolide resistance
- - Patients without risk factors for macrolide resistance
- Duration of therapy
- Tolerability and compliance
- Antibiotic regimens
- - Bismuth quadruple therapy
- - Clarithromycin-based therapy
- Triple therapy
- Concomitant therapy
- Hybrid therapy
- Sequential therapy
- - Levofloxacin based therapy
- CONFIRMATION OF ERADICATION
- TREATMENT FAILURE
- Factors associated with antibiotic treatment failure
- Salvage therapy for persistent H. pylori infection
- - Suggested approach
- - Salvage regimens
- ADJUVANT THERAPIES WITH UNCLEAR ROLE
- TREATMENT DURING PREGNANCY AND LACTATION
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS