Treatment of Persistent H. pylori Infection in Atrophic Gastritis with True Penicillin Allergy
This protocol applies to patients with environmental metaplastic atrophic gastritis who have H. pylori infection that has persisted after a previous eradication attempt — and who carry a true penicillin allergy. That allergy meaningfully narrows which salvage regimens can be used.
Clinical Scenario
True Penicillin AllergyThe patient is treatment-experienced: prior H. pylori eradication therapy did not achieve clearance. "Salvage therapy" refers to any regimen given to patients with persistent infection after that initial treatment has failed. A confirmed true penicillin allergy further restricts which salvage options are appropriate.
Treatment Approach (Partial Overview)
Of the available salvage regimens, only one specific multi-drug combination is both recommended and suitable when a true penicillin allergy is present. The course runs for 14 days. The complete regimen, component agents, dosing schedule, and supporting evidence are available in the full protocol.
Clinical Goal
Successful eradication of H. pylori must be confirmed by a test of cure — urea breath test, fecal antigen test, or biopsy-based test — performed at least 4 weeks after completing therapy.
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 who have not previously received BQT, optimized BQT is suggested (conditional recommendation; very low quality of evidence).
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 weeks after completion of therapy.
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