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Approach to the treatment of persistent Helicobacter pylori infection in adults

Approach to the treatment of persistent Helicobacter pylori infection in adults
This is an approach to selecting a salvage regimen for the treatment of persistent H. pylori infection. Key principles for selecting a regimen include the number and type of prior regimens, attention to local patterns of H. pylori antibiotic resistance, results of antimicrobial susceptibility testing, if available, and optimized acid suppression. Refer to UpToDate content on the treatment of H. pylori infection for details.

BQT: bismuth quadruple therapy; H. pylori: Helicobacter pylori; PPI: proton pump inhibitor.

* All patients who undergo treatment for H. pylori should receive confirmation of eradication with fecal antigen test, urea breath test, or upper endoscopy and biopsy. Testing should occur at least 4 weeks after H. pylori treatment completion and at least 2 weeks after stopping acid suppression medications.

¶ Refer to UpToDate content for details of treatment regimens, including medication doses and dosing frequency.

Δ Few clinical data exist to guide regimen selection in these patients, but H. pylori resistance to rifabutin and amoxicillin is low.

◊ Patients should be re-treated with BQT only if the initial BQT regimen included either (a) substitution of doxycycline for tetracycline or (b) metronidazole dose <1.5 g/day.

§ For details on H. pylori antimicrobial susceptibility testing, refer to UpToDate content on the diagnosis and treatment of H. pylori infection.

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