Helicobacter pylori: Difference between revisions

Revision as of 01:37, 8 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

Duration: 14 days
First-line:
- PBMT (PPI, bismuth, metronidazole, tetracycline)
- PAMC (PPI, amoxicillin, metronidazole, clarithromycin)
- 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 262 mg 2 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

References

^ M. Zamani, F. Ebrahimtabar, V. Zamani, W. H. Miller, R. Alizadeh‐Navaei, J. Shokri‐Shirvani, M. H. Derakhshan. Systematic review with meta‐analysis: the worldwide prevalence of Helicobacter pylori infection. Alimentary Pharmacology & Therapeutics. 2018;47(7):868-876. doi:10.1111/apt.14561.
^ G. Manes, A. Balzano, G. Iaquinto, C. Ricci, M. M. Piccirillo, N. Giardullo, A. Todisco, M. Lioniello, D. Vaira. Accuracy of the stool antigen test in the diagnosis of Helicobacter pylori infection before treatment and in patients on omeprazole therapy. Alimentary Pharmacology & Therapeutics. 2001;15(1):73-79. doi:10.1046/j.1365-2036.2001.00907.x.

@@ Line 1: / Line 1: @@
+== Background ==
-* Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
-* Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
-* Major cause of peptic ulcer disease and gastric cancer
+*Slow-growing [[Stain::Gram-negative]] microaerophilic [[Shape::bacillus]] with a curve, gull-wing, or spiral appearance
+*Oxidase-[[Oxidase::positive]] and urease-[[Urease::positive]]
+*Major cause of peptic ulcer disease and gastric cancer
+== Management ==
+* Duration: 14 days
+* First-line:
+** PBMT (PPI, bismuth, [[metronidazole]], [[tetracycline]])
+** PAMC (PPI, [[amoxicillin]], [[metronidazole]], [[clarithromycin]])
+** 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 262 mg 2 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
 {{DISPLAYTITLE:''Helicobacter pylori''}}
 [[Category:Gram-negative bacilli]]