Helicobacter pylori: Difference between revisions

Revision as of 21:45, 7 March 2021

Background

Slow-growing Gram-negative microaerophilic bacillus with a curve, gull-wing, or spiral appearance
Oxidase-positive and urease-positive
Major cause of peptic ulcer disease and gastric cancer

Management

Treatment is with combination therapy for 14 days followed by confirmation of eradication
First-line:
- PBMT (PPI, bismuth, metronidazole, tetracycline) (BMT Quad)
- PAMC (PPI, amoxicillin, metronidazole, clarithromycin) (CLAMET Quad)
- PAC (PPI, amoxicillin, clarithromycin), PMC (PPI, metronidazole, clarithromycin), or PAM (PPI, amoxicillin, metronidazole) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%
Prior treatment failure:
- PBMT (PPI, bismuth, metronidazole, tetracycline)
- PAL (PPI, amoxicillin, levofloxacin)
- PAR (PPI, amoxicillin, rifabutin) as last-line
Doses:
- PBMT
  - Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
  - Metronidazole 500 MG PO tid or qid
  - PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg
    - Some areas use double dosing
  - Tetracycline 500 mg PO qid
- Others
  - Amoxicillin 1000 mg PO bid
  - Clarithromycin 500 mg PO bid
  - Levofloxacin 500 mg PO daily
  - Metronidazole 500 mg PO bid
  - Rifabutin 150 mg PO bid
  - PPI as above
Duration: 14 days
Confirmation of eradication should be done 4 weeks following treatment

H. pylori Enhanced Primary Care Pathway: 2016 version, 2019 version, 2020 version
The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults. Gastroenterol. 2016;151:51–69. doi: 10.1053/j.gastro.2016.04.006
Houston Consensus Conference on Testing for Helicobacter pylori Infection in the United States. Clin Gastroenterol Hepatol. 2018;16(7):992-1002.e6. doi: 10.1016/j.cgh.2018.03.013

@@ Line 1: / Line 1: @@
-== Background ==
+==Background==
 *Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
@@ Line 5: / Line 5: @@
 *Major cause of peptic ulcer disease and gastric cancer
-== Management ==
+==Management==
+*Treatment is with combination therapy for 14 days followed by confirmation of eradication
-* Duration: 14 days
-* First-line:
+*First-line:
-** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
+**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]]) (BMT Quad)
-** PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]])
+**PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]]) (CLAMET Quad)
-** PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%
+**PAC (PPI, [[amoxicillin]], [[clarithromycin]]), PMC (PPI, [[metronidazole]], [[clarithromycin]]), or PAM (PPI, [[amoxicillin]], [[metronidazole]]) only in areas with clarithromycin resistance <15% or with proven high local eradication rates >85%
-* Prior treatment failure:
+*Prior treatment failure:
-** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
+**PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
-** PAL (PPI, [[amoxicillin]], [[levofloxacin]])
+**PAL (PPI, [[amoxicillin]], [[levofloxacin]])
-** PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line
+**PAR (PPI, [[amoxicillin]], [[rifabutin]]) as last-line
-* Doses:
+*Doses:
-** PBMT
+**PBMT
-*** Bismuth subsalicylate 262 mg 2 tablets PO qid
+***Bismuth subsalicylate 524 mg (2x 262 mg tablets) PO qid
-*** [[Metronidazole]] 500 MG PO tid or qid
+***[[Metronidazole]] 500 MG PO tid or qid
-*** PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg
+***PPI: esomeprazole 20 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, or rabeprazole 20 mg
-**** Some areas use double dosing
+****Some areas use double dosing
-*** Tetracycline 500 mg PO qid
+***Tetracycline 500 mg PO qid
-** Others
+**Others
-*** Amoxicillin 1000 mg PO bid
+***Amoxicillin 1000 mg PO bid
-*** Clarithromycin 500 mg PO bid
+***Clarithromycin 500 mg PO bid
-*** Levofloxacin 500 mg PO daily
+***Levofloxacin 500 mg PO daily
-*** Metronidazole 500 mg PO bid
+***Metronidazole 500 mg PO bid
-*** Rifabutin 150 mg PO bid
+***Rifabutin 150 mg PO bid
-*** PPI as above
+***PPI as above
+*Duration: 14 days
+*Confirmation of eradication should be done 4 weeks following treatment
+== Further Reading ==
+* ''H. pylori'' Enhanced Primary Care Pathway: [[2016 version]], [https://divisionsbc.ca/sites/default/files/inline-files/HPYLORI%20Enhanced%20Primary%20Care%20Pathway%202019_0.pdf 2019 version], [https://www.specialistlink.ca/files/HPylori_PCPathway_April112020.pdf 2020 version]
+* The Toronto Consensus for the Treatment of ''Helicobacter pylori'' Infection in Adults. ''Gastroenterol''. 2016;151:51–69. doi: [https://doi.org/10.1053/j.gastro.2016.04.006 10.1053/j.gastro.2016.04.006]
+* Houston Consensus Conference on Testing for ''Helicobacter pylori'' Infection in the United States. ''Clin Gastroenterol Hepatol''. 2018;16(7):992-1002.e6. doi: [https://doi.org/10.1016/j.cgh.2018.03.013 10.1016/j.cgh.2018.03.013]
 {{DISPLAYTITLE:''Helicobacter pylori''}}
 [[Category:Gram-negative bacilli]]