title: ACG Clinical Guideline: Treatment of Helicobacter pylori Infection.
abstract: 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.
authors.affiliation: Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA.
authors.forename: William D
authors.initials: WD
authors.lastname: Chey
authors.affiliation: Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada.
authors.forename: Grigorios I
authors.initials: GI
authors.lastname: Leontiadis
authors.affiliation: Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA.
authors.forename: Colin W
authors.initials: CW
authors.lastname: Howden
authors.affiliation: Division of Gastroenterology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
authors.forename: Steven F
authors.initials: SF
authors.lastname: Moss
mesh_terms: D000658:Amoxicillin / Q000627:therapeutic use; D000863:Antacids / Q000627:therapeutic use*; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D000890:Anti-Infective Agents / Q000627:therapeutic use; D001729:Bismuth / Q000627:therapeutic use; D017291:Clarithromycin / Q000627:therapeutic use; D004359:Drug Therapy, Combination; D016481:Helicobacter Infections / Q000188:drug therapy*; D016480:Helicobacter pylori; D006801:Humans; D064704:Levofloxacin / Q000627:therapeutic use; D008795:Metronidazole / Q000627:therapeutic use; D054328:Proton Pump Inhibitors / Q000627:therapeutic use*; D016879:Salvage Therapy; D017211:Treatment Failure
chemical_list: D000863:Antacids; D000900:Anti-Bacterial Agents; D000890:Anti-Infective Agents; D054328:Proton Pump Inhibitors; D008795:Metronidazole; D064704:Levofloxacin; D000658:Amoxicillin; D017291:Clarithromycin; D001729:Bismuth