Chey, W., Leontiadis, G., Howden, C. and Moss, S. (2017). ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. American Journal of Gastroenterology, 112(2), pp.212-239.

Article: ACGManagementofHpyloriGuideline2017

When I was researching for an article, I was looking to answer ways to treat a failed first line treatment H. pylori antibiotic therapy.

When the first line treatment did not work, we should proceed to the “Salvage treatment”, this consist not repeating the antibiotics used before (the patient mostly has resistance). According to this article, my patient could start on the “concomitant, Rifabutin triple, or High-dose dual-containing salvage regimen”. We should check for antibiotics resistance and verify which antibiotics would work best.

Concomitant therapy has PPI (standard dose) BID, Clarithromycin (500 mg) BID, Amoxicillin (1 grm) BID, and Nitroimidazole (500 mg) for 10–14 days. This regimen was studied in Japan showing 83% (95% CI 73-93%) success, but in other countries, the result was not reproducible. There are very little evidence on the best duration of the treatment.

Rifabutin triple regimen has PPI, amoxicillin, and rifabutin for 10 days. Rifabutin has been proven to be effective against H. pylori, but it is also very expensive.

High-dose dual therapy consists of a PPI 40mg QID and amoxicillin 750mg QID for 14 days. the study in Germany comparing its efficacy against bismuth quadruple therapy was not very significantly different: dual therapy: 76%, 95% CI 60-88% versus quadruple therapy: 81%, 95% CI 67-92%.

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