ACG Clinical Guideline

Treatment of Helicobacter pylori Infection

William D. Chey, Grigorios I. Leontiadis, Colin Howden, Steven F. Moss

Research output: Contribution to journalReview article

153 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)212-238
Number of pages27
JournalAmerican Journal of Gastroenterology
Volume112
Issue number2
DOIs
StatePublished - Feb 1 2017

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Helicobacter Infections
Helicobacter pylori
Guidelines
Clarithromycin
Bismuth
Therapeutics
Levofloxacin
Anti-Bacterial Agents
Idiopathic Thrombocytopenic Purpura
Iron-Deficiency Anemias
Dyspepsia
Amoxicillin
Macrolides
Metronidazole
Peptic Ulcer
Aspirin
Ulcer
Stomach Neoplasms
Decision Making
Anti-Inflammatory Agents

All Science Journal Classification (ASJC) codes

  • Hepatology
  • Gastroenterology

Cite this

ACG Clinical Guideline : Treatment of Helicobacter pylori Infection. / Chey, William D.; Leontiadis, Grigorios I.; Howden, Colin; Moss, Steven F.

In: American Journal of Gastroenterology, Vol. 112, No. 2, 01.02.2017, p. 212-238.

Research output: Contribution to journalReview article

Chey, William D. ; Leontiadis, Grigorios I. ; Howden, Colin ; Moss, Steven F. / ACG Clinical Guideline : Treatment of Helicobacter pylori Infection. In: American Journal of Gastroenterology. 2017 ; Vol. 112, No. 2. pp. 212-238.
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