Sandbox/guillermo
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Principles of Eradication Therapy for Helicobacter pylori infection
- Indications for diagnosis and treatment, established:[1]
- Active peptic ulcer disease.
- Confirmed history of peptic ulcer disease not previously treated for H. pylori.
- Gastric MALT lymphoma.
- After endoscopic resection of early gastric cancer.
- Uninvestigated dyspepsia (review H. pylori prevalence).
- Low clarithromycin resistance areas (<15%):[2]
- In areas of low resistance the PPI-clarithromycin-containing triple therapy is recommended as the first-line treatment as well as bismuth-containing quadruple therapy.
- In areas of low resistance after failure of a PPI-clarithromycin-containing treatment, either a bismuth-containing quadruple therapy or levofloxacin-containing triple therapy is recommended.
- High clarithromycin resistance areas (≥15%):[2]
- In areas of high resistance, bismuth-containing quadruple therapy are recommended for first-line treatment.
- In areas of high resistance after failure of bismuth containing quadruple therapy, levofloxacin containing triple therapy is recommended.
- After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing.[2]
- FDA approved first line regimens duration:[1]
- Triple therapy: 7 days (10 days if rabeprazole).
- Quadruple therapy: 4 weeks.
- Confirm the eradication of H. pylori infection in patients who have had an H. pylori-associated ulcer or gastric MALT lymphoma or who have undergone resection for early gastric cancer.[3]
- The urea breathing test is the most reliable nonendoscopic test to document eradication of H. pylori infection.[1]
- Testing to prove H. pylori eradication is most accurate if performed at 4 weeks after the completion of eradication therapy.[3]
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† There is a reported prevalence of 15% in the Northeast of the US.
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Helicobacter pylori Eradication Therapies
▸ Click on the following categories to expand treatment regimens.[1][8][9][3][10][11]
First line ▸ Triple therapy ▸ Quadruple therapy Second line ▸ Triple therapy ▸ Sequential therapy ▸ Hybrid therapy Third line therapy (Rescue therapy) ▸ Rifabutin based |
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References
- ↑ 1.0 1.1 1.2 1.3 Chey WD, Wong BC, Practice Parameters Committee of the American College of Gastroenterology (2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection". Am J Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.
- ↑ 2.0 2.1 2.2 Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F; et al. (2012). "Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report". Gut. 61 (5): 646–64. doi:10.1136/gutjnl-2012-302084. PMID 22491499.
- ↑ 3.0 3.1 3.2 McColl KE (2010). "Clinical practice. Helicobacter pylori infection". N Engl J Med. 362 (17): 1597–604. doi:10.1056/NEJMcp1001110. PMID 20427808.
- ↑ 4.0 4.1 Mégraud F (2004). "H pylori antibiotic resistance: prevalence, importance, and advances in testing". Gut. 53 (9): 1374–84. doi:10.1136/gut.2003.022111. PMC 1774187. PMID 15306603.
- ↑ 5.0 5.1 Duck WM, Sobel J, Pruckler JM, Song Q, Swerdlow D, Friedman C; et al. (2004). "Antimicrobial resistance incidence and risk factors among Helicobacter pylori-infected persons, United States". Emerg Infect Dis. 10 (6): 1088–94. doi:10.3201/eid1006.030744. PMC 3323181. PMID 15207062.
- ↑ 6.0 6.1 De Francesco V, Giorgio F, Hassan C, Manes G, Vannella L, Panella C; et al. (2010). "Worldwide H. pylori antibiotic resistance: a systematic review". J Gastrointestin Liver Dis. 19 (4): 409–14. PMID 21188333.
- ↑ 7.0 7.1 Boyanova L, Mitov I (2010). "Geographic map and evolution of primary Helicobacter pylori resistance to antibacterial agents". Expert Rev Anti Infect Ther. 8 (1): 59–70. doi:10.1586/eri.09.113. PMID 20014902.
- ↑ Garza-González E, Perez-Perez GI, Maldonado-Garza HJ, Bosques-Padilla FJ (2014). "A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication". World J Gastroenterol. 20 (6): 1438–49. doi:10.3748/wjg.v20.i6.1438. PMC 3925853. PMID 24587620.
- ↑ O'Connor A, Molina-Infante J, Gisbert JP, O'Morain C (2013). "Treatment of Helicobacter pylori infection 2013". Helicobacter. 18 Suppl 1: 58–65. doi:10.1111/hel.12075. PMID 24011247.
- ↑ Song M, Ang TL (2014). "Second and third line treatment options for Helicobacter pylori eradication". World J Gastroenterol. 20 (6): 1517–28. doi:10.3748/wjg.v20.i6.1517. PMC 3925860. PMID 24587627.
- ↑ Majumdar, Debabrata; Bebb, James; Atherton, John (2007). "Helicobacter pylori infection and peptic ulcers". Medicine. 35 (4): 204–209. doi:10.1016/j.mpmed.2007.01.006. ISSN 1357-3039.