ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

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-st...

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Veröffentlicht in:The American journal of gastroenterology Jg. 112; H. 2; S. 212 - 239
Hauptverfasser: Chey, William D, Leontiadis, Grigorios I, Howden, Colin W, Moss, Steven F
Format: Journal Article
Sprache:Englisch
Veröffentlicht: United States Wolters Kluwer Health Medical Research, Lippincott Williams & Wilkins 01.02.2017
Schlagworte:
Amoxicillin - therapeutic use
Antacids - therapeutic use
Anti-Bacterial Agents - therapeutic use
Anti-Infective Agents - therapeutic use
Bismuth - therapeutic use
Clarithromycin - therapeutic use
Drug Therapy, Combination
Gastroenterology
Helicobacter Infections - drug therapy
Helicobacter pylori
Humans
Levofloxacin - therapeutic use
Metronidazole - therapeutic use
Proton Pump Inhibitors - therapeutic use
Salvage Therapy
Treatment Failure
ISSN:0002-9270, 1572-0241, 1572-0241
Online-Zugang:Volltext
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Zusammenfassung: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.
Bibliographie:ObjectType-Article-1
SourceType-Scholarly Journals-1
ObjectType-Feature-2
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ObjectType-Instructional Material/Guideline-3
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ISSN:0002-9270
1572-0241
1572-0241
DOI:10.1038/ajg.2016.563