Guidelines for the salvage therapy

Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2], Sargun Singh Walia M.B.B.S.[3]

2017 ACG Guidelines for first-line treatment strategies of peptic ulcer disease for providers in North America

Strong recommendation

In patients with persistent H. pylori infection, every effort should be made to avoid antibiotics that have been previously taken by the patient.

The following regimens can be considered for use as salvage treatment: 1.Bismuth quadruple therapy for 14 days is a recommended salvage regimen. 2.Levofloxacin triple regimen for 14 days is a recommended salvage regimen.

Conditional recommendation

Bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options if a patient received a first-line treatment containing clarithromycin. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics.

Clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options, if a patient received first-line bismuth quadruple therapy. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics.

The following regimens can be considered for use as salvage treatment: 1.Concomitant therapy for 10–14 days is a suggested salvage regimen. 2.Clarithromycin triple therapy should be avoided as a salvage regimen. 3.Rifabutin triple regimen consisting of a PPI, amoxicillin, and rifabutin for 10 days is a suggested salvage regimen. 4.High-dose dual therapy consisting of a PPI and amoxicillin for 14 days is a suggested salvage regimen.