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The ACG’s 2007 treatment guideline on the management of H. pylori infection (26) listed the following as established indications for diagnosis and treatment:

Active PUD (gastric or duodenal).

Confirmed history of PUD (not previously treated for H. pylori)

Gastric MALT lymphoma (low grade).

After endoscopic resection of EGC.

Recommenend first line treatment for Helicobacter pylori

Regimen Drug dose Dosing frequency Duration(days)
Clarithromycin triple PPI(standard or double dose

Clarithromycin(500mg)

Amoxicillin(1gm)or Metronidazole(500mg TID)

BID 14 days
Bismuth Quadruple PPI(standard dose)

Bismuth subcitrate (120-300mg)or Subsalicylate (300mg)

Tetracyclin(500mg)

Metronidazole(250-500mg)

BID

QID

QID

TID to QID (500mg)

10-14 days
Concomitant PPI (standard dose)

Clarithromycin (500mg)

Amoxicillin(1gm)

Nitroimidazole(500mg)

BID 10 -14 days
Sequential PPI(standard dose)+Amoxicillin(1gm)

PPI,Clarithromycin(500mg)+Nitroimidazole(500mg)

BID

BID

5-7 days

5-7 days

Hybrid PPI(standard)+Amoxicillin(1gm)

PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg)

BID

BID

7 days

7 days

Levofloxacin triple PPI(standard dose)

Levofloxacin(500mg)

Amoxicillin(1gm)

BID

QID

BID

10-14 days
Levofloxacin sequential PPI(standard or double dose)+Amoxicillin(1 gm)

PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg)

BID

BID

5-7 days
LOAD Levofloxacin(250mg)

PPI(double dose)

Nitazoxanide(500mg)

Doxycycline(100mg)

QD

QD

BID

QD

7-10 days

Adjuvant therapy in the treatment of H. pylori infection. Emerging evidence suggests an inhibitory effect of Lactobacillus and Bifidobacterium species on H. pylori. Furthermore, these probiotic strains may also help to reduce the side effects of eradication therapies and improve compliance with therapy.

Selection of a first-line H. pylori treatment regimen:
             |,|-|-|+|-|-|^|-|-|.|   
             B01    B02   B03   B04
 
 
 
A01