Sandbox MKK
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) | FDA approval |
|---|---|---|---|---|
| Clarithromycin triple | PPI(standard or double dose
Clarithromycin(500mg) Amoxicillin(1gm)or Metronidazole(500mg TID) |
BID | 14 days | YES† |
| 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 | NO‡ |
| Concomitant | PPI (standard dose)
Clarithromycin (500mg) Amoxicillin(1gm) Nitroimidazole(500mg) |
BID | 10 -14 days | NO |
| Sequential | PPI(standard dose)+Amoxicillin(1gm)
PPI,Clarithromycin(500mg)+Nitroimidazole(500mg) |
BID
BID |
5-7 days
5-7 days |
NO |
| Hybrid | PPI(standard)+Amoxicillin(1gm)
PPI,Amoxicillin,Clarithromycin(500mg),Nitroimidazole(500mg) |
BID
BID |
7 days
7 days |
NO |
| Levofloxacin triple | PPI(standard dose)
Levofloxacin(500mg) Amoxicillin(1gm) |
BID
QID BID |
10-14 days | NO |
| Levofloxacin sequential | PPI(standard or double dose)+Amoxicillin(1 gm)
PPI,Amoxicillin,Levofloxacin(500mg QD),Nitroimidazole(500mg) |
BID
BID |
5-7 days | NO |
| LOAD | Levofloxacin(250mg)
PPI(double dose) Nitazoxanide(500mg) Doxycycline(100mg) |
QD
QD BID QD |
7-10 days | NO |
†: Several PPI,Clarithromycin and Amoxicillin combination have achieved FDA approval ,PPI,Clarithromycin,Metronidazole is not an FDA approved treatment regimen.
‡: PPI,Bismuth,Tetracycline and metronidazole precribed separately is not an FDA approval treatment regimen .However ,Pylera,a combination product conataining Bismuth subcitrate,Tetracycline ,Metronidazole combination with PPi for 10 days is an FDA approved regimen.
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 firstline Treatment
| •Is there a penicillin (PCN) allergy? •Previous macrolide (MCL) exposure for any reason ? | |||||||||||||||||||||||||||||||||||||
| •PCN allergy: No •MCL exposure: No | •PCN allergy: No •MCL exposure: Yes | •PCN allergy: Yes •MCL exposure: No | •PCN allergy: Yes •MCL exposure: Yes | ||||||||||||||||||||||||||||||||||
| Recomended treatment: •Bismuth quadruple •Clarithromycin triple with amoxicillin Other options: •Sequential •HYBRID •Levofloxacin triple •Levofloxacin sequential •LOAD | Recomended treatment: •Bismuth quadruple •Levofloxacin sequential Other options: •Concomitant therapy •Sequential therapy • HYBRID •LOAD | Recomended treatment: •Bismuth quadruple •Clarithromycin triple with metronidazole •Bismuth quadruple | Recomended treatment: •Bismuth quadruple •Clarithromycin triple with metronidazole •Bismuth quadruple | ||||||||||||||||||||||||||||||||||
| Persistent Helicobacter pylori infection | |||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
| Patient recieved clarithromycin triple therapy | Patient received Bismuth quadriple therapy | ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
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