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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