New Guidelines Show Best Practices for H pylori Treatment
In addition, antibiotic resistance testing is recommended after multiple treatment failures.
A review published in Current Treatment Options in Gastroenterology summarizes 3 recently published guidelines on the management of Helicobacter pylori: the Toronto consensus statement, the Maastricht V/Florence consensus report, and the American College of Gastroenterology guidelines on H pylori.
Study authors David J. Bjorkman and Matthew Steenblik, from the University of Utah School of Medicine, Salt Lake City, Utah, compared and contrasted the recommendations and offered a best practice approach for integrating the 3 guidelines.
With regards to treatment approach, the authors recommend antibiotic selection be based on local and individual resistance patterns, as the efficacy of previously established treatment regimens for H pylori have diminished over time with increasing antibiotic resistance.
A 14-day course of bismuth- or antibiotic-based quadruple therapy should be considered first-line treatment, while triple therapy with clarithromycin should not be used unless the local resistance rate is <15%. Second-line therapy, such as quadruple bismuth-based therapy or levofloxacin-based therapy, can be considered when first-line therapy has failed. In addition, antibiotic resistance testing is recommended after multiple treatment failures.
"Additional efforts are needed to define local antibiotic resistance to allow susceptibility-based treatment. In the meantime, 14-day quadruple therapy with bismuth or concomitant antibiotics is recommended as an empiric first-line treatment approach," conclude the authors.
Bjorkman DJ, Steenblik M. Best practice recommendations for diagnosis and management of Helicobacter pylori-synthesizing guidelines [published online September 21, 2017.] Curr Treat Options Gastroenterol. doi: 10.1007/s11938-017-0157-8.