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H. Pylori Infection Treatments
| H. PYLORI INFECTION TREATMENTS | ||
|---|---|---|
| Allergy | Previous macrolide exposure1 | No previous macrolide exposure |
| RECOMMENDATIONS | ||
|
Penicillin |
• Bismuth quadruple |
• Clarithromycin triple with metronidazole
• Bismuth quadruple |
|
No penicillin allergy |
• Bismuth quadruple • Alternative regimens3 |
• Bismuth quadruple • Clarithromycin triple with amoxicillin • Concomitant2 • Alternative regimens3 |
| FIRST-LINE REGIMENS3 | ||
| Regimen | Drugs/Dosing | Duration (days) |
|
Clarithromycin triple4,5 |
• PPI (standard or double dose twice daily) PLUS • clarithromycin (500mg twice daily) PLUS • amoxicillin (1g twice daily) OR |
14 |
|
Bismuth quadruple6 |
• PPI (standard dose twice daily) PLUS • bismuth subcitrate (120–300mg 4 times daily) or subsalicylate (300mg 4 times daily) PLUS • tetracycline (500mg 4 times daily) PLUS • metronidazole (250mg 4 times daily or 500mg 3–4 times daily) |
10–14 |
|
Concomitant2,7 |
• PPI (standard dose twice daily) PLUS • clarithromycin (500mg twice daily) PLUS • amoxicillin (1g twice daily) PLUS • metronidazole or tinidazole (500mg twice daily) |
10–14 |
| NOTES | ||
|
Key: PPI = proton pump inhibitor; LOAD = levofloxacin + omeprazole + Alinia + doxycycline 1 Includes patients in regions where clarithromycin resistance is known to be >15%. 2 Not an FDA-approved regimen. 3 For suggested alternative regimens that are not FDA-approved (eg, sequential, hybrid, levofloxacin triple or sequential, and LOAD), please consult ACG’s H. pylori infection clinical guideline. 4 Several PPIs (eg, Prilosec, Nexium, Prevacid, Aciphex) in combination with clarithromycin and amoxicillin have achieved FDA approval. PPI + clarithromycin + metronidazole is not an FDA-approved regimen. 5 Clarithromycin triple therapy should be avoided if clarithromycin resistance is >15%. 6 Not an FDA-approved regimen if prescribed separately. Pylera (bismuth subcitrate/tetracycline/metronidazole) combined with omeprazole for 10 days is FDA-approved. 7 First-line option for patients with intolerance to bismuth.
For FDA-approved regimens, see drug monographs at www.eMPR.com or contact company for full drug labeling. |
||
| REFERENCE | ||
|
Chey WD, Leontiadis GI, Howde CW, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017; 112:212-238; doi:10.1038/ajg.2016.563; published online 10 January 2017. (Rev. 1/2023) |
||
