Treatment
–Triple Rx: [PPI (standard dose BID) + Amoxicillin 1g BID + Clarithromycin 500mg BID] all three for 7-14 days. Will do a 10-day course. Will beware of increased clarithromycin resistance. Will consider alternate regiments.
-Confirming eradication: Will confirm eradication by repeating stool Ag test or Urea breath test after 6-8 weeks. Pt should preferably be off PPI as PPI decreases the sensitivity of stool antigen (H. Pylori RNA) testing.
Different types of treatment
Triple therapy: PAC (PPI, Amoxicillin, Clarithromycin)
Quadruple Tx: 14 day treatment with PPI (BID) + bismuth (2 tab QID) + Metronidazole (500mg TID) + Tetracycline (500mg QID) — 89% eradication.
Sequential Tx: 10-day regimen with PPI (BID for 10d) + amoxicillin (1g BID on d1-5) + clarithromycin (500mg BID on d5-10) + Metronidazole 500mg TID on d5-10).
Concomitant Rx: PAC-M (PPI, Amoxicillin, Clarithromycin, and Metronizadole)
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H. pylori pearls and Important links
- H. pylori Treatment failure
- When to confirm eradication: If treatment of PUD, dyspepsia sx persist, gastric MALT lymphoma, or early gastric CA.
Resources:
- Diagnosis and Treatment of Peptic Ulcer Disease and H. pylori Infection, AFP 2015, http://www.aafp.org/afp/2015/0215/p236.html
- https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2744171/