H Pylori

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H. Pylori

Indications

Common indications for H. Pylori diagnostic testing* 

  • Active peptic ulcer disease (PUD)
  • Low-grade gastric mucosa-associated lympoid tissue (MALT) lymphoma
  • Severe gastric atrophy
  • History of endoscopic resection of early gastric cancer

First line treatment

Triple Therapy

  • Clarithromycin 500mg PO every 12 hours for 14 days plus Amoxicilin 1g PO every 12 hours for 14 days plus PPI therapy from list below:
    • Lansoprazole 30mg every 12 hours
    • Omeprazole 20mg every 12 hours
    • Esomeprazole 20mg every 12 hours or 40mg every 24 hours
    • Pantoprazole 40mg every 12 hours
    • Rabeprazole 20mg every 12 hours

Quadruple Therapy**

  • Triple Therapy plus Bismuth Potassium Citrate 220mg PO every 12 hours before meals

Penicillin alternative

  • Substitute Metronidazole PO 500mg every 8 hours for Amoxicillin in “Triple Therapy”

Duration

  • 14 days

Notes

Pylera (a combination product containing bismuth subcitrate, tetracycline, and metronidazole) is an FDA-approved treatment regimen.

  • 3 tablets PO QID plus a PPI for 10 days 

*Serologic testing (IGG positive for H.Pylori) in the setting of the above indications is adequate for the diagnosis and warrants therapy.

**Addition of bismuth in the above triple therapies can improve the eradication rate by 30% to 40% in resistant H. pylori strains.

Disclaimer: The contents of this application are for the exclusive and specific use of University of Mississippi Medical Center faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only. The contents of this application are for the exclusive and specific use of UMMC faculty and trainees. Any other use is neither authorized nor sanctioned by UMMC. The information is for educational purposes only.