This protocol covers peptic ulcer disease in patients who remain Helicobacter pylori-positive after a prior eradication attempt and who also have a documented true penicillin allergy. The combination of treatment failure and allergy status narrows the safe therapeutic options to a specific pathway.
The patient is treatment-experienced: a previous H. pylori eradication course was completed, yet infection persists. A true penicillin allergy is documented, which rules out penicillin-class antibiotics and eliminates several standard eradication regimens that would otherwise be available. These two factors together define the management situation addressed here.
Among recognised salvage options for treatment-experienced patients, only a bismuth-based quadruple therapy is considered appropriate when true penicillin allergy is present — other regimens are not suitable in this context. The complete regimen, including the specific agents and their timing, is detailed in the full protocol.
Clinical goal: Confirmed eradication of H. pylori, verified by a urea breath test, fecal antigen test, or biopsy-based test performed no earlier than 4 weeks after completing therapy.
DOI: 10.14309/ajg.0000000000002968
Of the recommended and suggested salvage regimens, only optimized BQT is suitable for patients with a true penicillin allergy.
In summary, optimized BQT for 14 days is the preferred option for treatment-experienced patients with persistent H. pylori infection who have not been treated with optimized BQT previously and for whom the H. pylori resistance 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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