What are the treatment options for acute gastritis?

Updated: Jul 12, 2020
  • Author: Sarah El-Nakeep, MD; Chief Editor: BS Anand, MD  more...
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Answer

No specific therapy exists for acute gastritis, except for cases caused by H pylori. The American College of Gastroenterology (ACG) guidelines suggest that the current evidence does not support the notion that treating H pylori worsens gastroesophageal reflux disease (GERD). [14] For patients who need eradication of H pylori, this should not be a concern.

First-line H pylori eradication therapy

First-line therapy for H pylori eradication consists of bismuth quadruple therapy with a proton-pump inhibitor (PPI), a nitroimidazole, and tetracycline for 10-14 days or  clarithromycin-based triple therapy with amoxicillin or amitronidazole and a PPI for 14 days (both strong recommendations). [14] Other first-line options are concomitant (14 days of clarithromycin, amoxicillin, and a nitroimidazole) or  sequential (first week with amoxicillin and second week with clarithromycin and a nitroimidazole) or  hybrid therapy (amoxicillin for 14 days, then adding clarithromycin and a nitroimidazole on the second week only). [14]

Note that the guidelines mention a nitroimidazole molecule in general (metronidazole or tindazole), as they have similar efficacy, although tinidazole is not recommended as first-line therapy to avoid drug resistance. [14] As for levofloxacin-containing regimens, the quality of evidence is very low; these regimens could be used for 10-14 days, on a triple regimen of levofloxacin, amoxicillin, and a PPI. Another first-line therapy regimen is a fluoroquinolone sequential therapy with amoxicillin in the first week, followed by a PPI, fluoroquinolone with nitroimidazole in the second week.

Second-line or salvage therapy

Second-line therapy or salvage therapy depends on the antibiotics used in the first course of treatment and the culture results in cases of resistant strains. Levofloxacin- and rifabutin-based salvage regimens have a better degree of evidence than bismuth- or clarithromycin-based regimens. [14, 15] See the table below.

Acute gastritis. Acute gastritis treatment options Acute gastritis. Acute gastritis treatment options according to latest American College of Gastroenterology (ACG) guidelines.

In a 2020 systematic review, investigators found nitazoxanide was effective in treatment-naïve patients as well as for salvage therapy. [16] This anti-protozoal drug increases the efficacy of multidrug regimens and could provide a good alternative in regions where multidrug resistance is endemic. Nitazoxanide is generally well tolerated and could also be of benefit in children. [16]


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