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Helicobacter pylori Tx recommendations updated

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Recommendations have been updated for treatment of Helicobacter pylori in adults, according to a new consensus statement.

Dr Carlo A Fallone, from the McGill University Health Centre in Montreal, and colleagues conducted a systematic literature review and developed specific, updated recommendations for eradication therapy in adults with H. pylori infection.

The researchers strongly recommend that all H. pylori regimens should be given for 14 days because of the increasing failure of therapy. Concomitant nonbismuth quadruple therapy (proton pump inhibitor [PPI] + amoxicillin + metronidazole + clarithromycin [PAMC]) and traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline [PBMT]) were included as recommended first-line strategies. Use of PPI triple therapy (PPI + clarithromycin + amoxicillin or metronidazole) should be limited to regions with low resistance to clarithromycin or high eradication success with these regimens. PBMT and levofloxacin-containing therapy were included as recommended rescue therapies.

Rifabutin therapy should be used only for patients who have failed to respond to three or more previous treatment regimens.

“Optimal treatment of H. pylori infection requires careful attention to local antibiotic resistance and eradication patterns,” the authors write. “The quadruple therapies PAMC or PBMT should play a more prominent role in eradication of H. pylori infection, and all treatments should be given for 14 days.”

Abstract
Background & Aims: Helicobacter pylori infection is increasingly difficult to treat. The purpose of these consensus statements is to provide a review of the literature and specific, updated recommendations for eradication therapy in adults.
Methods: A systematic literature search identified studies on H pylori treatment. The quality of evidence and strength of recommendations were rated according to the Grading of Recommendation Assessment, Development and Evaluation (GRADE) approach. Statements were developed through an online platform, finalized, and voted on by an international working group of specialists chosen by the Canadian Association of Gastroenterology.
Results: Because of increasing failure of therapy, the consensus group strongly recommends that all H pylori eradication regimens now be given for 14 days. Recommended first-line strategies include concomitant nonbismuth quadruple therapy (proton pump inhibitor [PPI] + amoxicillin + metronidazole + clarithromycin [PAMC]) and traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline [PBMT]). PPI triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole) is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens. Recommended rescue therapies include PBMT and levofloxacin-containing therapy (PPI + amoxicillin + levofloxacin). Rifabutin regimens should be restricted to patients who have failed to respond to at least 3 prior options.
Conclusions: Optimal treatment of H pylori infection requires careful attention to local antibiotic resistance and eradication patterns. The quadruple therapies PAMC or PBMT should play a more prominent role in eradication of H pylori infection, and all treatments should be given for 14 days.

Authors
Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, Jones NL, Render C, Leontiadis GI, Moayyedi P, Marshall JK

Infectious Disease Advisor material
Gastroenterology abstract


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