Treatment of Peptic Ulcer Disease with Active H. pylori Infection — Treatment-Naive
This protocol addresses peptic ulcer disease in patients with confirmed, active Helicobacter pylori infection who have never received H. pylori eradication therapy and have no penicillin allergy.
Clinical scenario
Active H. pylori infection has been confirmed by a nonserological test. No prior eradication attempt has been made (treatment-naive), and antibiotic susceptibility results are not yet available. Penicillin allergy is absent.
Treatment approach
Empiric first-line eradication therapy is recommended when antibiotic susceptibility is unknown; the preferred approach involves a bismuth-based quadruple regimen, with suitable empiric alternatives available for specific patient profiles.
Treatment goals
Confirmed eradication of H. pylori infection, verified by a negative urea breath test, fecal antigen test, or biopsy-based test performed at least 4 weeks after completing therapy.
References
DOI: 10.14309/ajg.0000000000002968
- We summarize treatment recommendations for patients with active H. pylori infection, as confirmed by a nonserological test, who have not been previously treated (i.e., "treatment-naive" patients) and those with persistent infection despite previous attempt(s) at eradication (i.e., "treatment-experienced" patients).
- Rifabutin triple therapy or PCAB dual therapy for 14 days are suitable alternatives as empiric therapy in patients without penicillin allergy.
- In treatment-naive patients with H. pylori infection, optimized BQT is recommended as a first-line treatment option (strong recommendation; moderate quality evidence).
- For treatment-naive patients with H. pylori infection, BQT (preferably optimized) for 14 days is the preferred option when the antibiotic susceptibility profile is unknown.
- 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.
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