Materiały źródłowe

• #1 Treatment of Helicobacter pylori infection: Current and future insights

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4714294/

  Helicobacter pylori (H. pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide. H. pylori treatment still remains a challenge, since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance, mucosal drug concentration, patient compliance, side-effect profile and cost. While no new drug has been developed, current therapy still relies on different mixture of known antibiotics and anti-secretory agents. A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen. Bismuth-containing quadruple treatment, sequential treatment or a non-bismuth quadruple treatment (concomitant) are also an alternative therapy. Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H. pylori after defeat of first-line therapy. The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies. Therefore, adding probiotic to the medications, developing anti-H. pylori photodynamic or phytomedicine therapy, and achieving a successful H. pylori vaccine may have the promising to present synergistic or additive consequence against H. pylori, because each of them exert different effects.

• #2 Treatment of Helicobacter pylori infection: Current and future insights

  https://www.wjgnet.com/2307-8960/full/v4/i1/5.htm

  Treatment of Helicobacter pylori infection: Current and future insights. Helicobacter pylori (H. pylori) is an important major cause of peptic ulcer disease and gastric malignancies such as mucosa-associated lymphoid tissue lymphoma and gastric adenocarcinoma worldwide. H. pylori treatment still remains a challenge, since many determinants for successful therapy are involved such as individual primary or secondary antibiotics resistance, mucosal drug concentration, patient compliance, side-effect profile and cost. While no new drug has been developed, current therapy still relies on different mixture of known antibiotics and anti-secretory agents. A standard triple therapy consisting of two antibiotics and a proton-pump inhibitor proposed as the first-line regimen. Bismuth-containing quadruple treatment, sequential treatment or a non-bismuth quadruple treatment (concomitant) are also an alternative therapy. Levofloxacin containing triple treatment are recommended as rescue treatment for infection of H. pylori after defeat of first-line therapy. The rapid acquisition of antibiotic resistance reduces the effectiveness of any regimens involving these remedies. Therefore, adding probiotic to the medications, developing anti-H. pylori photodynamic or phytomedicine therapy, and achieving a successful H. pylori vaccine may have the promising to present synergistic or additive consequence against H. pylori, because each of them exert different effects.

• #3 H. pylori Infection: ACG Updates Treatment Recommendations | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p135.html

  Testing for Helicobacter pylori is indicated for certain conditions, such as peptic ulcer disease, and it should be treated in any patient who tests positive. […] Any patient who tests positive for Helicobacter pylori infection should be treated. […] Patients with low-grade gastric mucosa-associated lymphoid tissue lymphoma or a history of endoscopic resection of early gastric cancer should also be tested. […] Helicobacter pylori is typically treated with a combination of antibiotics plus a proton pump inhibitor (PPI). […] There is no regimen with a 100% cure rate for Helicobacter pylori infection, and there are few, if any, regimens with a 90% cure rate. […] Clarithromycin triple therapy consists of a PPI, clarithromycin (Biaxin), and amoxicillin or metronidazole (Flagyl) for 14 days.

• #3 H. pylori Infection: ACG Updates Treatment Recommendations | AAFP

  https://www.aafp.org/pubs/afp/issues/2018/0115/p135.html

  Bismuth quadruple therapy consists of a PPI, bismuth, tetracycline, and a nitroimidazole for 10 to 14 days. […] Concomitant therapy consists of a PPI, clarithromycin, amoxicillin, and a nitroimidazole (tinidazole [Tindamax] or metronidazole) for 10 to 14 days. […] Sequential therapy consists of a PPI and amoxicillin for five to seven days followed by a PPI, clarithromycin, and a nitroimidazole for five to seven days. […] Bismuth quadruple therapy (PPI, bismuth, tetracycline, metronidazole) for 14 days or levofloxacin triple therapy (PPI, levofloxacin, amoxicillin) for 14 days are the recommended salvage regimens. […] Allergy testing may be considered after one or two failures of first-line therapy.

• #4 Patient education: Helicobacter pylori infection and treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/helicobacter-pylori-infection-and-treatment-beyond-the-basics/print

  HELICOBACTER PYLORI TREATMENT […] People with a history of peptic ulcer disease, active gastric ulcer, or active duodenal ulcer associated with H. pylori infection should be treated. Successful treatment of H. pylori can help the ulcer to heal, prevent ulcers from coming back, and reduce the risk of ulcer complications (like bleeding). Guidelines in the United States and other countries recommend that patients who require long-term anti-inflammatory medications such as aspirin, ibuprofen, naproxen, and similar drugs treatment for arthritis and other medical conditions should be tested for H. pylori and if infected undergo treatment to eradicate the H. pylori infection. […] Medications — No single drug cures H. pylori infection. Most treatment regimens involve taking several medications for 14 days. Most of the treatment regimens include a medication called a proton pump inhibitor. This medication decreases the stomach’s production of acid, which allows the tissues damaged by the infection to heal. Examples of proton pump inhibitors include lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), rabeprazole (AcipHex), dexlansoprazole (Dexilant), and esomeprazole (Nexium). Two antibiotics are also generally recommended; this reduces the risk of treatment failure and antibiotic resistance. There are increasing numbers of patients with H. pylori infection that is resistant to antibiotics, so it is important to take all the medications prescribed for the entire course, typically 10 to 14 days, and then have a test that confirms that the infection has been cleared.

• #4 Patient education: Helicobacter pylori infection and treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/helicobacter-pylori-infection-and-treatment-beyond-the-basics/print

  Treatment failure — Up to 20 percent of patients with H. pylori infection are not cured after completing their first course of treatment. A second treatment regimen is usually recommended in this case. Retreatment usually requires that the patient take 14 days of a proton pump inhibitor plus two antibiotics and bismuth subsalicylate („quadruple therapy”). At least one of the antibiotics is different from those used in the first treatment course. […] Follow-up — After completing H. pylori treatment, repeat testing is recommended to ensure that the infection has been eradicated. This is typically done with a breath or stool test. Blood tests are not recommended for initial diagnosis or follow up testing; the antibody detected by the blood test often remains in the blood for four or more months after treatment, even after the infection is eliminated.

• #4 Patient education: Helicobacter pylori infection and treatment (Beyond the Basics) – UpToDate

  https://www.uptodate.com/contents/helicobacter-pylori-infection-and-treatment-beyond-the-basics/print

  Side effects — Up to 50 percent of patients have side effects while taking H. pylori treatment. Side effects are usually mild, and fewer than 10 percent of patients stop treatment because of side effects. For those who do experience side effects, it may be possible to make adjustments in the dose or timing of medication. Some of the most common side effects are described below. Some of the treatment regimens use a medication called metronidazole (Flagyl) or clarithromycin (Biaxin). These medications can cause a metallic taste in the mouth and nausea. Alcoholic beverages (eg, beer, wine) should be avoided while taking metronidazole; the combination can cause skin flushing, headache, nausea, vomiting, sweating, and a rapid heart rate. Bismuth, which is contained in some of the regimens, causes the stool to become black and may cause constipation. Many of the regimens cause diarrhea and stomach cramps.

• #5 Treatment of Helicobacter pylori Infection

  https://www.mdcalc.com/guidelines/10363/acg/treatment-helicobacter-pylori-infection

  Treat if active H. pylori infection. […] Test if active PUD, history of PUD (unless known H. pylori test of cure), low-grade MALT lymphoma, or history of resected early gastric CA; if positive, then treat. […] Test with gastric biopsy if functional dyspepsia and undergoing EGD; if positive, then treat (NNT = 14 for cure of functional dysplasia). […] Consider testing if long-term, low-dose ASA use to reduce risk of GIB; if positive, then treat. […] Test if starting chronic course of NSAIDs (unclear benefit if already on NSAIDs); if positive, then treat. […] Test if unexplained iron deficiency anemia; if positive, then treat. […] Test if adult with ITP; if positive, then treat. […] If failed 1st line therapy and reports PCN allergy, consider allergy testing can safely treat most with amoxicillin-containing salvage regimens.

• #6 Helicobacter pylori (H. pylori) infection – Diagnosis & treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/h-pylori/diagnosis-treatment/drc-20356177

  H. pylori infections are usually treated with at least two different antibiotics at once. This helps prevent the bacteria from developing a resistance to one particular antibiotic. […] Treatment may also include medications to help your stomach heal, including: […] Proton pump inhibitors (PPIs). These drugs stop acid from being produced in the stomach. Some examples of proton pump inhibitors (PPIs) are omeprazole (Prilosec), esomeprazole (Nexium), lansoprazole (Prevacid) and pantoprazole (Protonix). […] Bismuth subsalicylate. More commonly known by the brand name Pepto-Bismol, this drug works by coating the ulcer and protecting it from stomach acid. […] Histamine (H-2) blockers. These medications block a substance called histamine, which triggers acid production. One example is cimetidine (Tagamet HB). histamine (H-2) blockers are only prescribed for H. pylori infection if PPIs can’t be used. […] Repeat testing for H. pylori at least four weeks after your treatment is recommended. If the tests show the treatment didn’t get rid of the infection, you may need more treatment with a different combination of antibiotics.

• #7 H. pylori Infection: Symptoms, Causes, and Treatment

  https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori

  Ulcers caused by H. pylori are usually treated with a combination of antibiotics and a proton pump inhibitor (PPI). […] Triple therapy: Therapies that combine PPIs with two antibiotics remain the first-line options for treating H. pylori. […] Antibiotics: Your doctor will probably prescribe two antibiotics to keep the bacteria from building up a resistance to a particular one. Amoxicillin, clarithromycin (Biaxin), metronidazole (Flagyl), tetracycline (Sumycin), or tinidazole (Tindamax) are likely options. […] Proton pump inhibitors (PPIs): These drugs reduce the acid in your stomach by blocking the tiny „pumps,” or glands, that produce it. They include esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix), and rabeprazole (Aciphex). […] Bismuth subsalicylate: This medication, often used as an over-the-counter diarrhea remedy, is often recommended along with antibiotics to further protect your stomach.

• #7 H. pylori Infection: Symptoms, Causes, and Treatment

  https://www.webmd.com/digestive-disorders/h-pylori-helicobacter-pylori

  Histamine (H-2) blockers: These block the chemical histamine, which prompts your stomach to make more acid. These include cimetidine (Tagamet), and nizatidine (Axid AR). H-2 blockers are only used when you can’t take PPIs. […] Most ulcers caused by H. pylori will heal after a few weeks. Don’t take nonsteroidal anti-inflammatory drugs (NSAIDs) like aspirin, ibuprofen, and naproxen for pain, since they can damage your stomach lining. If you need pain medicine, talk to your doctor. […] Your doctor may retest you for H. pylori about 4 weeks after you finish your treatment. If you still show signs of an infection, you might need to take another round of different antibiotics.

• #8 Helicobacter pylori Infection Treatment: Helicobacter pylori Infection Treatment

  https://emedicine.medscape.com/article/2172395-overview

  Regimens for eradication of Helicobacter pylori infection are typically chosen empirically, on the basis of regional bacterial resistance patterns, local recommendations, and drug availability. Therapy for H pylori infection has undergone major changes, based on application of the principles of antimicrobial stewardship and increased availability of susceptibility testing. Common initial choices for empiric treatment include a 14-day bismuth-based quadruple therapy or rifabutin-based triple therapy. However, clinicians should use regimens shown to be highly effective locally. […] In addition, health care providers should ask their patients about any prior antibiotic use or exposure, and take that information into consideration in the choice of a treatment regimen. […] A Cochrane meta-analysis of 55 studies concluded that 14 days is the optimal duration of triple therapy, achieving an H pylori eradication rate of 81.9%, whereas 7 days attains an eradication rate of only 72.9%.

• #8 Helicobacter pylori Infection Treatment: Helicobacter pylori Infection Treatment

  https://emedicine.medscape.com/article/2172395-overview

  Rifabutin-based regimens are recommended as rescue or salvage therapies when first-line agents fail. […] While it is yet to be included in treatment guidelines, vonoprazan triple therapy has been proposed as an alternative first-line regimen for clarithromycin-sensitive strains, given its similar or greater effectiveness as PPIs. […] Non-bismuth quadruple therapy may be given sequentially or concomitantly. […] Sequential therapy (a suggested first-line option) is superior to standard triple therapy, according to two systematic reviews, and consists of the following: PPI plus amoxicillin for 5-7 days, then PPI plus 2 other antibiotics for the next 5-7 days. […] Concomitant therapy is better for clarithromycin-resistant strains, and 14 days of concomitant therapy is superior to 14-day triple therapy, with cure rates of 90%.

• #8 Helicobacter pylori Infection Treatment: Helicobacter pylori Infection Treatment

  https://emedicine.medscape.com/article/2172395-overview

  Bismuth-based therapy is an alternative first-line therapy (in areas with high clarithromycin and metronidazole resistance, and in patients with prior macrolide exposure or penicillin-allergic) or second-line therapy. […] Duration is 10-14 days. […] Second-line therapy should avoid repeating first-line regimens that were already used, and should incorporate at least one different antibiotic. […] Before initiating rescue/third-line therapy, send ulcer biopsy specimen for culture and antimicrobial susceptibility testing. […] The preferred treatments for patients who have received a clarithromycin-containing first-line regimen are bismuth quadruple therapy or levofloxacin-salvage combination therapy. […] Bismuth-based quadruple therapy is used for 14 days and comprises the following (eradication rates for all combinations below were above 90%). […] Levofloxacin-based sequential therapy is superior to clarithromycin- and tetracycline-based therapies and consists of the following (eradication rates of up to 92.2%, as long as the H pylori was susceptible to levofloxacin).

• #9 Eradication of Helicobacter pylori infection: Which regimen first?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921476/

  A first-line eradication regimen should be based on what works best in a defined geographical area and must take into account the prevalence of antimicrobial resistance in that region. […] First-line therapy for Helicobacter pylori infection should have an efficacy higher than 90% to prevent the need for additional treatment and the emergence of secondary antimicrobial resistance. […] Non-bismuth quadruple (i.e., concomitant) therapy appears to have high efficacy and, in our opinion, is the first choice of treatment for eradicating the infection. […] The use of probiotics has attracted attention as an alternative approach for increasing eradication rates and decreasing treatment-related side effects. […] Based on a large body of published clinical trials, a quinolone-containing triple therapy has proven to be effective as a first-line therapy for H. pylori infection.

• #9 Eradication of Helicobacter pylori infection: Which regimen first?

  https://pmc.ncbi.nlm.nih.gov/articles/PMC3921476/

  The eradication rates of levofloxacin-containing triple therapy ranged from 72% to 96%. […] The standard sequential therapy regimen consists of a 5-d dual therapy with a PPI (standard dose, bid) and amoxicillin (1 g, bid) followed by a 5-d triple therapy with a PPI (standard dose, bid), clarithromycin (500 mg, bid), and metronidazole/tinidazole (500 mg, bid). […] Recently, several studies have shown that a 10-d sequential therapy can achieve a promising success rate of 85%-90%. […] The mechanism by which sequential administration of antimicrobials is effective despite clarithromycin resistance remains to be fully elucidated. […] Concomitant therapy is another novel regimen that proved to be successful in the presence of clarithromycin resistance. […] This therapy is superior to standard triple therapy for H. pylori eradication and is also less complex than sequential therapy.

• #10 ACG Guideline on Treatment of Helicobacter pylori: New Recommendations… Will Practice Change? – American College of Gastroenterology

  https://gi.org/journals-publications/ebgi/schoenfeld_sep2024/

  Optimized bismuth-based quadruple therapy (BQT) for 14-days is the recommended therapy for treatment-naïve patients as well as treatment-experienced patients who failed to eradicate H. pylori with an initial course of PPI-clarithromycin triple therapy. […] The guideline specifically recommends against using PPI-clarithromycin triple therapy unless antibiotic sensitivity has been performed and clarithromycin-sensitivity has been proven. […] The key concepts section also emphasizes that proof of H. pylori eradication is required in all patients after treatment by obtaining a fecal antigen test, urea breath testing, or gastric biopsy. […] Finally, the authors recommend expanding the indications for testing and treating H. pylori to include individuals at increased risk of gastric cancer, individuals with atrophic gastritis, gastric intestinal metaplasia, and household members of adults with H. pylori infection based on non-serologic testing.

• #11

  https://journals.lww.com/ajg/fulltext/2024/09000/acg_clinical_guideline__treatment_of_helicobacter.13.aspx

  Helicobacter pylori is a prevalent, global infectious disease that causes dyspepsia, peptic ulcer disease, and gastric cancer. For treatment-naive patients with H. pylori infection, bismuth quadruple therapy (BQT) for 14 days is the preferred regimen when antibiotic susceptibility is unknown. Rifabutin triple therapy or potassium-competitive acid blocker dual therapy for 14 days is a suitable empiric alternative in patients without penicillin allergy. In treatment-experienced patients with persistent H. pylori infection, optimized BQT for 14 days is preferred for those who have not been treated with optimized BQT previously and for whom antibiotic susceptibility is unknown. In patients previously treated with optimized BQT, rifabutin triple therapy for 14 days is a suitable empiric alternative. Salvage regimens containing clarithromycin or levofloxacin should only be used if antibiotic susceptibility is confirmed. The CPG also addresses who to test, the need for universal post-treatment test-of-cure, and the current evidence regarding antibiotic susceptibility testing and its role in guiding the choice of initial and salvage treatment.

• #11

  https://journals.lww.com/ajg/fulltext/2024/09000/acg_clinical_guideline__treatment_of_helicobacter.13.aspx

  The primary purpose of this ACG CPG is to provide practical, actionable advice on the treatment of H. pylori infection in North America. […] For treatment-naive patients with H. pylori infection, BQT (preferably optimized) for 14 days is the preferred option when the antibiotic susceptibility profile is unknown. Rifabutin triple therapy or PCAB dual therapy for 14 days are suitable alternatives as empiric therapy in patients without penicillin allergy. […] In treatment-experienced patients with persistent H. pylori infection who have not previously received BQT, optimized BQT is suggested. […] In treatment-experienced patients with persistent H. pylori infection who have previously received PPI-clarithromycin triple therapy, optimized BQT is suggested. […] In treatment-experienced patients with persistent H. pylori infection, levofloxacin triple therapy is suggested in patients with known levofloxacin-sensitive H. pylori strains and when optimized bismuth quadruple or rifabutin triple therapies have previously been used or are unavailable.

• #12 First-line treatment H. pylori infection treatment-naïve adults – UpToDate

  https://www.uptodate.com/contents/image?imageKey=GAST/112171

  First-line treatment regimens for H. pylori infection in treatment-naïve adults. […] The table shows first-line treatment regimens for Helicobacter pylori infection in treatment-naïve individuals. For information on regimen selection, refer to UpToDate content on the treatment of H. pylori infection. […] The doses in this table are for patients with normal kidney and hepatic function. For dosing adjustments in those with kidney and/or hepatic function impairment, refer to the Lexidrug monographs included within UpToDate. […] BQT: bismuth quadruple therapy; PPI: proton pump inhibitor; USD: United States dollars. […] Antibiotics should be dosed with or shortly after meals. […] In the United States, bismuth subsalicylate is available as a 262 mg chewable tablet. Bismuth subsalicylate should not be used in patients with salicylate allergy; bismuth subcitrate is an acceptable alternative. […] Doxycycline should not be substituted for tetracycline because doxycycline is associated with lower H. pylori eradication success. […] This regimen should be reserved for use in patients with documented clarithromycin-susceptible strains.

• #13 Helicobacter Pylori

  https://mobile.fpnotebook.com/GI/ID/HlcbctrPylr.htm

  Treatment duration: Treat for 14 days to maximize eradication rates […] Use at least 3 agents in most cases (generally avoid 2 agent regimens, esp. for salvage therapy) […] If failed therapy – see resistant cases below […] Consider concurrent Probiotic […] Add Saccharomyces boulardii and/or Lactobacillus to regimen […] Increases eradication rates and decreases Antibiotic Associated Diarrhea […] Bismuth Quadruple Therapy (BQT, up to 98% efficacy) […] Gold standard for Helicobacter Pylori due to highest efficacy, lowest resistance rates and lowest cost […] Compliance is difficult due to four time daily dosing […] Treatment for 7 day course […] First Trimester […] Lansoprazole (Prevacid) 30 mg orally twice daily AND Amoxicillin 1000 mg orally twice daily AND Metronidazole (Flagyl) 500 mg orally twice daily […] Second and Third Trimester […] Follow first trimester protocol […] Clarithromycin (Biaxin) 500 mg orally twice daily may be substituted for Metronidazole.

• #14 Helicobacter Pylori: A Review of Current Treatment Options in Clinical Practice

  https://www.mdpi.com/2075-1729/12/12/2038

  To minimize these concerns, local resistance rates must constantly be monitored to ensure that the most effective strategies are implemented. […] The bismuth quadruple therapy (BQT) is the recommended first-line initial treatment option when areas are exhibiting high levels (>15%) of clarithromycin resistance, and low-level dual clarithromycin and metronidazole resistance (<15%). [...] Depending on insurance coverage and affordability, the BQT regimen can be given as an FDA-approved three-in-one capsule, plus a PPI. [...] Clarithromycin triple therapy consists of a standard dose of PPI, clarithromycin 500 mg, and amoxicillin 1 g, all taken twice a day, or metronidazole 500 mg three times daily. [...] Recent studies have shown that the clarithromycin triple therapy eradicates about 77% of the population in the United States.

• #15 Management of Helicobacter pylori in 2023: who should be tested, treated, and how | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/management-of-helicobacter-pylori/

  Helicobacter pylori (H. pylori) continues to be an important pathogen associated with peptic ulcer disease, dyspepsia, and gastric cancer. […] Worldwide and in Canada the guidelines for the treatment of H. pylori infection changed in 2016. […] The conventional triple combination of a PPI, clarithromycin, and either amoxicillin or metronidazole is no longer recommended because its success rates have decreased to less than 60%. […] The new recommended first-line therapy is called concomitant or ClAMet (using the initials of clarithromycin, amoxicillin, and metronidazole) given for 14 days. Its efficacy is 80-85%. […] The best second-line therapy is bismuth-based quadruple therapy (PPI, bismuth, metronidazole, and tetracycline) given for 14 days. […] The third-line therapy is the combination of a PPI, amoxicillin, and levofloxacin given for 14 days.

• #15 Management of Helicobacter pylori in 2023: who should be tested, treated, and how | This Changed My Practice (TCMP) by UBC CPD

  https://thischangedmypractice.com/management-of-helicobacter-pylori/

  There is a fourth-line therapy consisting of a PPI with amoxicillin and rifabutin. […] If the above-listed four therapies are given in sequence to individuals who failed higher order therapies, the cumulative success rate is 96-97%. […] It is important that patients get a clear explanation about these treatments, preferably with a handout. […] It is generally recommended to test whether treatment was successful. […] Given that none of the current H. pylori therapies are 100% successful it is my practice to always test whether cure has been received after each treatment. […] There is evidence that anti-Helicobacter therapy is effective in the treatment of H. pylori positive gastric or duodenal ulcers. […] It is recommended that all 1st degree relatives of gastric cancer patients are tested and, if positive, treated for Helicobacter, especially if the index case occurred at a younger age.

• #16

  https://www.bumrungrad.com/en/health-blog/september-2024/new-american-guidelines-for-helicobacter-pylori-treatment

  New American Guidelines for Helicobacter pylori Treatment […] Recognizing the serious health risks of H. pylori, leading gastroenterology experts have released new treatment guidelines. These updates emphasize the importance of effective treatment protocols, especially in light of rising antibiotic resistance. Here is what you need to know to manage H. pylori infection effectively. […] The new guidelines provide different treatment options for first-time patients and those with persistent infections, aiming to improve effectiveness by overcoming antibiotic resistance. […] First-Line Treatment for First-Time Patients: […] Optimized Bismuth Quadruple Therapy (BQT): Combines a proton pump inhibitor (PPI), bismuth, tetracycline, and metronidazole. This is highly recommended for first-time patients due to its effectiveness.

• #16

  https://www.bumrungrad.com/en/health-blog/september-2024/new-american-guidelines-for-helicobacter-pylori-treatment

  Rifabutin Triple Therapy: A newer therapy combining rifabutin (a strong antibiotic), amoxicillin, and a PPI. It is a good alternative for patients needing a first-line treatment. […] PCAB and Amoxicillin Dual Therapy: This combination of a potassium-competitive acid blocker (PCAB) and amoxicillin is another effective first-line treatment option, especially in cases where clarithromycin resistance is suspected. […] PCAB-Clarithromycin Triple Therapy: For patients with unknown clarithromycin resistance, this therapy (PCAB, clarithromycin, and a PPI) is recommended over traditional PPI-based treatments. […] Treatment for Patients with Persistent H. pylori Infections: […] For patients whose first treatment did not work, the following options are recommended: […] Bismuth Quadruple Therapy (BQT): This therapy is still the top recommendation for patients who did not respond to initial treatment. It is especially effective if the patient has not received BQT before.

• #17 A New First-Line Treatment Regimen for H. pylori Infectionlogo-32logo-40logo-60NEJM Journal WatchnejmJW_1L_RGB-b

  https://www.jwatch.org/na51502/2020/05/08/new-first-line-treatment-regimen-h-pylori-infection

  A New First-Line Treatment Regimen for H. pylori Infection […] Treatment of Helicobacter pylori infection is decreasingly successful using standard treatment regimens due to increasing antibiotic resistance. […] Now, investigators report efficacy and safety findings for a novel rifabutin-based regimen, which was recently approved by the FDA for H. pylori treatment in adults. […] The eradication rate in the rifabutin-based therapy group was significantly higher (84%) compared with the comparison group (58%). […] No H. pylori resistance to rifabutin was detected, and side effects were similar between groups. […] Rifabutin-based triple therapy appears promising as a first-line empirical treatment as it has good clinical efficacy, no H. pylori resistance is shown, and it is well tolerated. Further studies are needed to compare this new triple therapy with current quadruple therapies.

• #18 H. Pylori Infection: How Do You Get, Causes, Symptoms, Tests & Treatment

  https://my.clevelandclinic.org/health/diseases/21463-h-pylori-infection

  H-pylori-caused ulcers are commonly treated with combinations of antibiotics and proton pump inhibitors. […] H. pylori-caused ulcers are treated with a combination of antibiotics and an acid-reducing proton pump inhibitor. […] Combination treatment is usually taken for 14 days. […] One newer medication, Talicia, combines two antibiotics (rifabutin and amoxicillin) with a proton pump inhibitor (omeprazole) into a single capsule.

• #19 University of Illinois Chicago

  https://dig.pharmacy.uic.edu/faqs/2025-2/january-2025-faqs/what-are-the-latest-guideline-recommendations-for-the-treatment-of-helicobacter-pylori-infection-in-the-u-s/

  Talicia (rifabutin, omeprazole, and amoxicillin) was approved by the U.S. Food and Drug Administration (FDA) for the treatment of H. pylori infection in 2019. Vonoprazan, a potassium-competitive acid blocker (PCAB), was FDA-approved for the treatment of H. pylori infection in 2022, and vonoprazan-containing regimens became available in December 2023. […] The 2024 ACG guideline reinforces the importance of using non-clarithromycin-based regimens for the initial and salvage treatment of H. pylori infection. The ACG recommends optimized bismuth quadruple therapy (BQT) for 14 days as the preferred regimen for treatment-naive patients for whom antibiotic susceptibility is unknown. For treatment-experienced patients with persistent H. pylori infection, optimized BQT for 14 days is again the preferred regimen for those who have not previously received BQT and for whom antibiotic susceptibility is unknown, or for those who failed to eradicate the infection with initial PPI-clarithromycin triple therapy.

• #20

  https://link.springer.com/article/10.1007/s11938-020-00300-3

  Increasing antibiotic resistance has reduced treatment effectiveness. […] Quadruple regimens (bismuth-based or concomitant/non-bismuth-based) have been recommended first-line. […] A rifabutin-based combination product recently approved by the US Food and Drug Administration is highly effective and should simplify treatment. […] The potassium-competitive acid blocker vonoprazan is being evaluated as part of dual or triple combination regimens. […] Effective management continues to comprise appropriate diagnostic testing for active infection, utilization of an effective regimen, and post-treatment testing. […] The most recent treatment guideline for US practice. […] Evidence that the simple addition of bismuth to a combination regimen may boost eradication rates. […] High-dose dual therapy is superior to standard first-line or rescue therapy for Helicobacter pylori infection.

• #21 Safety and effectiveness of dual therapy for Helicobacter pylori infection and the effect on the glycated hemoglobin level in type 2 diabetes | Scientific Reports

  https://www.nature.com/articles/s41598-025-85628-5

  Patients with diabetes have a high risk of failure of H. pylori eradication therapy. The present study aims to evaluate the efficacy and safety of vonoprazanamoxicillin (VA) dual therapy for the treatment of H. pylori infection in patients with type-2 diabetes mellitus (T2DM). The eradication rate in the intention-to-treat analysis and per-protocol analysis was 84.00% (63/75) and 87.14% (61/70), respectively. VA dual therapy is a safe and effective regimen for patients with T2DM. The Maastricht VI/Florence Consensus reports, and the Sixth Chinese Consensus on H. pylori infection recommends the 14-day bismuth quadruple therapy as a first-line treatment in areas with a high prevalence of clarithromycin resistance. However, these quadruple therapy regimens have some disadvantages, including high cost, numerous side effects, and poor treatment compliance due to the use of numerous drugs. According to a meta-analysis, T2DM patients have a higher risk of H. pylori eradication failure, when compared to non-diabetic patients (odds ratio [OR]: 2.59, 95% confidence interval [CI]: 1.823.70). In recent clinical studies, the eradication rate for vonoprazan (VPZ)-amoxicillin (3 g/d) dual therapy (VA dual therapy), as the first-line treatment, was approximately 89.5094.60%, showing acceptable efficacy and safety. The present study aimed to assess the effectiveness and safety of VA dual therapy in T2DM patients. The primary outcome measure for the present study was the H. pylori eradication rate. The overall incidence of AEs in the present trial was 13.3% (10/75), and none of the patients developed any severe AEs. After the three-month follow-up period, a significant decrease in A1C levels was observed (7.701.05 vs. 7.231.00, p=0.006). In conclusion, the present study revealed the efficacy and safety of the 14-day VA dual therapy for eradicating H. pylori in T2DM patients.

• #22 Management of refractory helicobacter pylori infection – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-refractory-helicobacter-pylori-infection/

  Guidance on the management of Helicobacter pylori (H. pylori) after an initial attempt at eradication therapy fails, including best practice advice on specific regimen selection, and consideration of patient and systems factors that contribute to treatment efficacy. […] 1. The usual cause of refractory H. pylori infection (persistent infection after attempting eradication therapy) is antibiotic resistance. Providers should attempt to identify other contributing etiologies, including inadequate adherence to therapy and insufficient gastric acid suppression. […] 2. Providers should conduct a thorough review of prior antibiotic exposures. If there is a history of any treatment with macrolides or fluoroquinolones, then clarithromycin- or levofloxacin-based regimens, respectively, should be avoided given the high likelihood of resistance. By contrast, resistance to amoxicillin, tetracycline and rifabutin is rare, and these can be considered for subsequent therapies in refractory H. pylori infection.

• #22 Management of refractory helicobacter pylori infection – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-refractory-helicobacter-pylori-infection/

• #22 Management of refractory helicobacter pylori infection – American Gastroenterological AssociationAGA Logo_Horizontal

  https://gastro.org/clinical-guidance/management-of-refractory-helicobacter-pylori-infection/

  6. In the absence of a history of anaphylaxis, penicillin allergy testing should be considered in a patient labeled as having this allergy in order to delist penicillin as an allergy and potentially enable its use. Amoxicillin should be used at a daily dose of at least 2 g divided 3 times per day or 4 times per day to avoid low trough levels. […] 7. Inadequate acid suppression is associated with H. pylori eradication failure. The use of high-dose and more potent PPIs, PPIs not metabolized by CYP2C19, or potassium-competitive acid blockers, if available, should be considered in cases of refractory H. pylori infection. […] 8. Longer treatment durations provide higher eradication success rates compared with shorter durations (eg, 14 days vs 7 days). Whenever appropriate, longer treatment durations should be selected for treating refractory H. pylori infection.

• #23

  https://journals.lww.com/ajg/fulltext/2017/02000/acg_clinical_guideline__treatment_of_helicobacter.12.aspx

  In patients with persistent H. pylori infection, every effort should be made to avoid antibiotics that have been previously taken by the patient. Bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options if a patient received a first-line treatment containing clarithromycin. Selection of the 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. The following regimens can be considered for use as salvage treatment: Bismuth quadruple therapy for 14 days is a recommended salvage regimen. Levofloxacin triple regimen for 14 days is a recommended salvage regimen. Concomitant therapy for 10-14 days is a suggested salvage regimen. Clarithromycin triple therapy should be avoided as a salvage regimen. Rifabutin triple regimen consisting of a PPI, amoxicillin, and rifabutin for 10 days is a suggested salvage regimen. High-dose dual therapy consisting of a PPI and amoxicillin for 14 days is a suggested salvage regimen.

• #24 Treatment of Helicobacter pylori infection: Current and future insights

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4714294/

  In high clarithromycin resistance areas, clarithromycin substitution by levofloxacin has been investigated. Levofloxacin sequential therapy showed eradication rate more than 96% in comparison with 80.8% clarithromycin sequential therapy. Levofloxacin-based sequential regimen is better than usual triple therapy as the first line in the sites with high incidence of resistance to clarithromycin.

• #24 Treatment of Helicobacter pylori infection: Current and future insights

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4714294/

  H. pylori treatment involves combination of antimicrobial and anti-secretory agents for 7 to 14 d. PPIs inhibit the parietal cell H+/K+ adenosine triphosphatase (ATPase), the enzyme of canalicular membrane of gastric parietal cells which is responsible for the last step in gastric acid secretion. […] The dosage and duration of treatment of PPIs for adults correspond to those that are able to suppress gastric acid secretion. Long-term omeprazole therapy in H. pylori positive patients induced changes in mucosal inflammation and glandular atrophy. […] Dual treatments including a PPI with either clarithromycin or amoxicillin or metronidazole were popular during the previous decades. Dual therapy is now obsolete due to lack of efficacy of clarithromycin and metronidazole. […] Several studies assumed that there is direct and indirect demonstration which stated high-dose PPI, above the common standards, could ameliorate H. pylori treatment cure rates.

• #24 Treatment of Helicobacter pylori infection: Current and future insights

  https://pmc.ncbi.nlm.nih.gov/articles/PMC4714294/

  In recent years, regimens that utilize proton-pump inhibitors (PPIs) in combination with several antibiotics such as amoxicillin plus clarithromycin or metronidazole have been considered as the first-line treatment for H. pylori infection. PPI-based triple therapy has been described to be losing its efficacy for H. pylori, with eradication cure rates as low as 50% to 70%, due to high rates of antibiotic resistance, high rates of antibiotic-associated side effects and low compliance. Decreased eradication rate has led to the development and use of new first-line treatment. […] The Maastricht IV/Florence Consensus Report recommended the bismuth-containing quadruple therapy as an alternative for first-line empirical treatment in areas with the clarithromycin resistance over 15%-20%. If this regimen is not available sequential therapy or a non-bismuth quadruple therapy (the so-called concomitant treatment) is recommended. After failure of a PPI-clarithromycin-containing treatment for H. pylori infection, either a bismuth-containing quadruple therapy or levofloxacin-based triple therapy is recommended as second-line treatment or rescue therapy.

• #25 Treatment of Helicobacter pylori infection: Current and future insights

  https://www.wjgnet.com/2307-8960/full/v4/i1/5.htm

  The Maastricht IV/Florence Consensus Report recommended the use of antimicrobial susceptibility testing (culture-guided therapy), after the failure of second-line treatment. However, culture-guided third-line therapy has been advised, but if antimicrobial sensitivity data are not available, an empirical triple or quadruple therapy can be recommended as third-line regimens. […] The differences in pharmacokinetics for example elimination half-life, bioavailability and metabolism of currently available PPIs may translate into differences in clinical outcomes. […] The dosage and duration of treatment of PPIs for adults correspond to those that are able to suppress gastric acid secretion. Long-term omeprazole therapy in H. pylori positive patients induced changes in mucosal inflammation and glandular atrophy.

• #25 Treatment of Helicobacter pylori infection: Current and future insights

  https://www.wjgnet.com/2307-8960/full/v4/i1/5.htm

  Dual treatments including a PPI with either clarithromycin or amoxicillin or metronidazole were popular during the previous decades. Dual therapy is now obsolete due to lack of efficacy of clarithromycin and metronidazole. […] Several studies assumed that there is direct and indirect demonstration which stated high-dose PPI, above the common standards, could ameliorate H. pylori treatment cure rates. […] The general idea in the back of high-dose PPI plus amoxicillin treatment is to overcoming resistance by altering the environment in which dormant H. pylori settled, thus inciting the bacteria to get in the replicative state and become sensitive to the antibiotics. […] A number of recently different regimens for the H. pylori treatments are described. […] The effectiveness of a triple bismuth-consisting regimen along with amoxicillin and nifuratel used for eradication of H. pylori in patients were evaluated. The results of this study revealed the therapy containing bismuth subcitrate, amoxicillin and nifuratel yielded a success rate of 86% in childhood.

• #25 Treatment of Helicobacter pylori infection: Current and future insights

  https://www.wjgnet.com/2307-8960/full/v4/i1/5.htm

  As such, during the last 30 years that the H. pylori was identified, there have been numerous therapeutic regimens suggested but a unique most effective and least harmful therapeutic regimen to cure H. pylori infection in all reported colonized individuals is still lacking. […] Despite the number of studies, the optimal treatment for H. pylori infection has not been found and routine clinical treatments are usually triple or quadruple antibiotic therapies. […] The most commonly used antibiotics are imidazole (metronidazole or tinidazol), macrolide (clarithromycin or azithromycin), tetracycline, amoxicillin, rifabutin and furazolidon. Bismuth, a heavy metal with anti-H. pylori activity is used in bismuth-based quadruple therapy and seems almost totally maintains high eradication rates, independent of antibiotic resistance.

• #25 Treatment of Helicobacter pylori infection: Current and future insights

  https://www.wjgnet.com/2307-8960/full/v4/i1/5.htm

  In recent years, regimens that utilize proton-pump inhibitors (PPIs) in combination with several antibiotics such as amoxicillin plus clarithromycin or metronidazole have been considered as the first-line treatment for H. pylori infection. PPI-based triple therapy has been described to be losing its efficacy for H. pylori, with eradication cure rates as low as 50% to 70%, due to high rates of antibiotic resistance, high rates of antibiotic-associated side effects and low compliance. Decreased eradication rate has led to the development and use of new first-line treatment. […] The Maastricht IV/Florence Consensus Report recommended the bismuth-containing quadruple therapy as an alternative for first-line empirical treatment in areas with the clarithromycin resistance over 15%-20%. If this regimen is not available sequential therapy or a non-bismuth quadruple therapy (the so-called concomitant treatment) is recommended. After failure of a PPI-clarithromycin-containing treatment for H. pylori infection, either a bismuth-containing quadruple therapy or levofloxacin-based triple therapy is recommended as second-line treatment or rescue therapy.

• #26 Newer Therapies for Refractory Helicobacter pylori Infection in Adults: A Systematic Review

  https://www.mdpi.com/2079-6382/13/10/965

  Newer regimens, such as high-dose PPI–amoxicillin dual therapy (HDDT), vonoprazan-based therapy, and rifabutin-containing triple therapy, offer alternative mechanisms of action and improved acid suppression, providing potential advantages over traditional rescue regimens. […] Results from clinical trials and meta-analyses have proven the effectiveness and safety of vonoprazan-based therapy as a first-line treatment in treating H. pylori infections, providing evidence for the use of vonoprazan in patients who have failed initial PPI-based therapy. […] Rifabutin-containing triple therapy has also demonstrated high efficacy with few adverse events and high treatment adherence. […] High-dose PPI and amoxicillin dual therapy, vonoprazan-based therapy, and rifabutin-based therapy have proven to be effective and safe rescue regimens for treating H. pylori infection. These regimens have generally achieved eradication rates exceeding 80%, with some studies reporting rates approaching 90%. The incidence of adverse events associated with these treatments was comparable to or lower than traditional rescue regimens, such as PPI-based triple therapy or bismuth quadruple therapy. Further well-designed large-scale randomized studies are required to determine the optimal doses and durations of various treatment regimens to achieve the highest eradication rate with the lowest incidence of adverse events among patients with refractory H. pylori infections.

• #27

  https://link.springer.com/article/10.1007/s00253-017-8535-7

  Due to fact that H. pylori has been regarded as a difficult-to-treat infection mainly because of acquired resistance to commonly used antibiotics, there is a growing interest in using probiotics in conjunction with antibiotic regimens to eradicate H. pylori. Probiotics have been proven to be useful in the treatment of several intestinal diseases such as diarrhea, in addition to the benefits of probiotic bacteria in the intestines; some beneficial effects on the stomach have been reported. Among them, the anti-Helicobacter pylori activity has been studied. […] The benefits of probiotic therapy in H. pylori case are increased eradication and improved tolerability by preventing the occurrence of treatment and related side effects. […] Related to probiotics, probiotics could not be recommended to be used as a single agent for eradication therapy. However, their use associated to standard treatment as an adjunct will improve the eradication rates and decrease treatment-related side effects.

• #28 Helicobacter pylori: A concise review of the latest treatments against an old foe | Cleveland Clinic Journal of Medicine

  https://www.ccjm.org/content/91/8/481

  The US Food and Drug Administration recently approved the P-CAB vonoprazan for treating H pylori infection. […] H pylori infection is the most common carcinogenic infection worldwide. Eradication therapy is indicated for all individuals who test positive for active H pylori infection. Due to the rising burden of antibiotic resistance, susceptibility testing for H pylori infection is recommended when local empiric therapy cure rates are less than 90%; testing is also recommended after a failed first treatment attempt. Several H pylori eradication therapies, including vonoprazan-based regimens, are available. Clinicians should tailor the therapy according to antimicrobial susceptibility testing results, the local antibiogram, cost, pill burden, and patient-related factors.

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