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Physicians can optimize H. pylori treatment through tailored therapy, antibiotic resistance considerations, and post-treatment eradication testing to enhance patient outcomes and reduce resistance.
To help healthcare providers in North America better manage the most common bacterial infection- Helicobacter pylori (H. pylori), the American College of Gastroenterology (ACG) has released updated clinical practice guidelines.
These most recent guidelines were devised using the Grading of Recommendations, Assessment, Development, and Evaluation (GRADE) approach. After reviewing 11 key clinical questions, experts came up with 6 major recommendations as per the available evidence and their own consensus, particularly where data was limited.
For patients newly diagnosed with H. pylori infection, the preferred treatment is a 14-day course of bismuth quadruple therapy (BQT), particularly when antibiotic resistance is not known. For individuals who do not have a penicillin allergy, options such as rifabutin triple therapy or dual therapy with potassium-competitive acid blockers can also suggested.
For patients treated earlier but still have the infection, an “optimized” version of BQT is preferred, unless they have already tried it. If they have, rifabutin triple therapy is a solid backup. However, salvage treatments involving clarithromycin or levofloxacin should only be considered when antibiotic resistance is established.
The guidelines also clarify when patients should be tested for H. pylori and emphasize the importance of testing for eradication after treatment. There is also a discussion on the role of antibiotic resistance testing, which can help guide both initial and follow-up treatments. Finally, the guidelines suggest areas for further research to fill in knowledge gaps and improve treatment strategies for H. pylori in North America.
The American Journal of Gastroenterology
ACG Clinical Guideline: Treatment of Helicobacter pylori Infection
Willian Chey et al.
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