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News

Guidelines for the treatment of H. pylori

February's issue of the American Journal of Gastroenterology reports on the American College of Gastroenterology's clinical guidelines on the treatment of H. pylori infection.

News image

Helicobacter pylori infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. 

Professor William Chey and colleagues from Michigan, USA reported on the American College of Gastroenterology clinical guidelines on the treatment of Helicobacter pylori infection.

The team report that Helicobacter pylori may 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 Helicobacter pylori, patients should be asked about previous antibiotic exposure, and this information should be incorporated into the decision-making process. 

Most patients will be better served by first-line treatment with bismuth quadruple therapy
American Journal of Gastroenterology
For first-line treatment, the team report that clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst Helicobacter pylori isolates is known to be low. 

The guidelines recommend that 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, the guidelines recommend that 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. 

Professor Chey's team comments, "Details regarding the drugs, doses and durations of the recommended and suggested first-line and salvage regimens can be found in the guideline."

Am J Gastroenterol 2017; 112: 212–238
13 February 2017

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