Treatment of Peptic Ulcer Disease When H. pylori Persists After Previous Eradication Therapy

This protocol is for treatment-experienced patients with peptic ulcer disease in whom Helicobacter pylori infection has not been eliminated after a prior eradication attempt and who have no penicillin allergy.

Clinical Scenario

Persistent H. pylori Infection Despite Initial Therapy

The term "salvage therapy" refers to any treatment given to patients with persistent H. pylori infection despite an initial course. This protocol targets that treatment-experienced population with confirmed ongoing infection and no penicillin allergy.

Treatment Approach (Partial Overview)

Bismuth-Based Quadruple Combination Therapy

For patients who have not previously received optimized bismuth quadruple therapy, this regimen is the suggested salvage approach — supported over alternative combination strategies. Complete agent selection, sequencing, and duration are detailed in the full structured protocol.

Clinical Goal

Confirmed Eradication

The aim is eradication of H. pylori infection, confirmed by a negative urea breath test, fecal antigen test, or biopsy-based test performed at least 4 weeks after completing therapy.

Instant Access to Structured Evidence-Based Regimens

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).
In treatment-experienced patients with persistent H. pylori infection who have previously received PPI-clarithromycin triple therapy, optimized BQT is suggested (conditional recommendation; low quality of evidence).
In treatment-experienced patients with persistent H. pylori infection who have not previously received optimized BQT, optimized BQT is suggested over quinolone-based therapy (conditional recommendation; 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 wk after completion of therapy.

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