Helicobacter pylori

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