A recent review (SE Crowe. NEJM 2019; 1158-65) provides a succinct summary of current H pylori management.
A couple of key points:
- It is essential to test for cure after treatment 1 month afterwards
- If retreatment is needed, use an alternative regimen
- In the discussion of treatment, Dr. Crowe does NOT emphasize quadruple therapy except in individuals with a clarithromycin resistance probability of >25% (based on geographic incidence rates) or prior macrolide use. She notes that in some populations that clarithromycin-based triple therapy had similar effectiveness as bismuth-based quadruple-based therapy. Table 2 lists the 7 ACG approved treatment regimens.
- It is noted that U.S. clarithromycin-resistance is between 21-30%.
Related blog posts:
- It’s Getting Harder to Treat H pylori –Here’s Why
- High Rates of Helicobacter Pylori Resistance
- What is Evidence-Based Medicine for Helicobacter… | gutsandgrowth
- Quadruple Therapy for Helicobacter Pylori Favored in Toronto Guidelines
- Salvage Therapy and Standard Therapy for H pylori | gutsandgrowth
- Updated Pediatric Helicobacter Pylori Guidelines
- Helicobacter pylori -useful advice | gutsandgrowth
- High Rates of Helicobacter Pylori Resistance | gutsandgrowth
- Understanding Resistance to Helicobacter pylori | gutsandgrowth
- Helicobacter Pylori: …and Dubious Beneficial Claims | gutsandgrowth
Disclaimer: These blog posts are for educational purposes only. Specific dosing of medications/diets (along with potential adverse effects) should be confirmed by prescribing physician/nutritionist. This content is not a substitute for medical advice, diagnosis or treatment provided by a qualified healthcare provider. Always seek the advice of your physician or other qualified health provider with any questions you may have regarding a condition.
