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ISG Guidelines on Diagnosis and Management of H. pylori

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Dr Vineet Ahuja, New Delhi    05 December 2018

  • Therapy of H. pylori should be based on local antibiotic resistance pattern, if possible.
  • The currently recommended first-line therapy for H. pylori infection includes a combination of proton pump inhibitor, amoxicillin, and clarithromycin in areas with low clarithromycin resistance.
  • There is an increasing rate of H. pylori resistance to clarithromycin and metronidazole leading to reduced efficacy of PPI based triple therapy.
  • Imidazole based triple therapy regimens should not be used for eradicating H. pylori.
  • In patients with failure of PPI, clarithromycin-amoxicillin triple therapy, a bismuth containing quadruple therapy or concomitant non-bismuth quadruple therapy is recommended as a second line treatment.
  • Fluoroquinolone based concomitant therapy may be used after second line failure.
  • Hybrid therapy is another alternative for first and second line failures.

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