Resistance to clarithromycin, metronidazole, and levofloxacin limits their effectiveness and increases the prevalence of Data on resistance are scarce. All rights Reserved.
These treatment recommendations are based on a series of questions.All patients with active or previous peptic ulcer disease should be tested for Based on low-quality evidence, the ACG also recommends testing for those initiating long-term nonsteroidal anti-inflammatory drug therapy, those with unexplained iron deficiency anemia, and adults with idiopathic thrombocytopenic purpura.Ideally, tests that identify active infection, such as a urea breath test, fecal antigen test, or endoscopic biopsy, should be used in the diagnosis of There is insufficient evidence to make a recommendation about testing and treatment in asymptomatic patients with a family history of gastric cancer or in patients with lymphocytic gastritis, hyperplastic gastric polyps, or hyperemesis gravidarum.Clarithromycin triple therapy consists of a PPI, clarithromycin (Biaxin), and amoxicillin or metronidazole (Flagyl) for 14 days. Copyright © 2018 by the American Academy of Family Physicians.Copyright © 2020 American Academy of Family Physicians. Treatment is for one week with a proton pump inhibitor or an antacid (or antisecretory agents), and two appropriate antibacterial agents. [] The most common route of H pylori infection is either oral-to-oral or fecal-to-oral contact. Blood test. More research is needed to determine local, regional, and national patterns of Resistance can be evaluated using culture or molecular testing; however, these methods are not widely available in the United States. However, in some parts of the world, a low incidence of H. pylori infection is not associated with higher allergy prevalence in children [ 44 ]. Extending sequential therapy to 14 days may improve eradication rates, but more studies are needed. Author disclosure: No relevant financial affiliations.• Patients should be asked about previous antibiotic exposure to help guide the treatment regimen and avoid failures because of resistance.• A urea breath test, fecal antigen testing, or biopsy-based testing should be used to determine treatment success.Because there is a lack of randomized controlled trials in North America (defined as the United States and Canada in this guideline) that assess modern treatment regimens, the ACG's treatment recommendations mostly rely on clinical trial data generated in other parts of the world.
However, breath and stool tests are better at detecting active H. pylori infections than is a blood test. recurrence after successful H. pylori eradication and ulcer healing.4 nsAiDs or aspirin The recommendations for H. pylori eradication in nonsteroidal anti-inflammatory drug (NSAID) users are summarised in Table 3.
Diagnosis.
Helicobacter pylori is a common occupant of the human gastrointestinal tract.Worldwide, it is estimated that up to half the population is infected, with more than three-quarters affected in many endemic areas, especially in developing countries. Bismuth quadruple therapy should be strongly considered as first-line treatment where clarithromycin resistance is high or in patients with any previous macrolide exposure.Concomitant therapy consists of a PPI, clarithromycin, amoxicillin, and a nitroimidazole (tinidazole [Tindamax] or metronidazole) for 10 to 14 days. The main determinants are choice of regimen, patient adherence to a multidrug regimen with frequent adverse effects, and the sensitivity of the Of the infection-related factors, antibiotic sensitivity was found to be the most important determinant of treatment success in clinical trials and population-based studies.