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Uptodate Reference Title
Approach to antibiotic treatment in patients with persistent Helicobacter pylori infection
Approach to antibiotic treatment in patients with persistent Helicobacter pylori infection
Clarithromycin-based triple therapy consists of clarithromycin, amoxicillin/metronidazole, and a PPI.
Bismuth quadruple therapy consists of bismuth subsalicylate or bismuth subcitrate, metronidazole, tetracycline, and a PPI.
Levofloxacin triple therapy consists of levofloxacin, amoxicillin/metronidazole, and a PPI.
High-dose dual therapy consists of amoxicillin and a PPI.
Rifabutin triple therapy consists of rifabutin, amoxicillin, and a PPI.
Clarithromycin-based concomitant therapy consists of clarithromycin, amoxicillin, nitroimidazole (eg, metronidazole), and a PPI.
* Eradication of H. pylori after antibiotic treatment may be confirmed by a urea breath test, stool antigen test, or upper endoscopy-based testing. A positive result on one of these tests is indicative of a persistent H. pylori infection. ¶ If known levofloxacin sensitive strain or the population levofloxacin resistance rates are known to be less than 15%. Δ Only in patients with no risk factors for macrolide resistance (no prior macrolide exposure and local clarithromycin resistance known to be <15%). This regimen should be avoided if local clarithromycin resistance is unknown. ◊ Eradication of H. pylori infection can be confirmed with a urea breath test, stool antigen testing, or upper endoscopy-based testing. The choice of test depends on the need for an upper endoscopy (eg, follow-up of bleeding peptic ulcer) and local availability. H. pylori serology should not be used to confirm eradication of H. pylori. Refer to UpToDate topic on diagnostic tests for H. pylori.