مرض القرحة الهضمية: عندما تستمر الملوية البوابية بعد العلاج الثلاثي بالريفابوتين

References

DOI: 10.14309/ajg.0000000000002968

• The umbrella term "salvage therapy" refers to any treatment provided to patients with persistent H. pylori infection despite initial therapy.
• Of the recommended and suggested salvage regimens, only optimized BQT is suitable for patients with a true penicillin allergy.
• In treatment-experienced patients with persistent H. pylori infection that is confirmed to be clarithromycin-sensitive, PPI- or PCAB-clarithromycin triple therapy is suggested.
• In treatment-experienced patients with persistent H. pylori infection, levofloxacin triple therapy is suggested in patients with known levofloxacin-sensitive H. pylori strains and when optimized bismuth quadruple or rifabutin triple therapies have previously been used or are unavailable (conditional recommendation, low quality of evidence).
• Although we do not recommend HDDT as a routine salvage regimen in patients with persistent H. pylori infection, it may be considered in selected scenarios such as patients in whom optimized BQT or rifabutin triple therapy is not an option; antibiotic susceptibility testing is unavailable or does not yield usable results; or in patients with a strain of H. pylori that is sensitive only to amoxicillin.
• All patients who are treated for H. pylori infection should undergo a test of cure with an appropriately conducted urea breath test, fecal antigen test, or biopsy-based test at least 4 wk after completion of therapy.