What are the ACG guidelines for the primary treatment of H pylori infection (HPI)?

Updated: Apr 26, 2021
  • Author: BS Anand, MD; Chief Editor: Philip O Katz, MD, FACP, FACG  more...
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The 2017 American College of Gastroenterology (ACG) guidelines for the treatment of H pylori infection strongly recommend 10-14 days of quadruple therapy with bismuth, a proton pump inhibitor (PPI), tetracycline, and a nitroimidazole). [33] An alternative strongly recommended option is 10-14 days of concomitant PPI, clarithromycin, amoxicillin, and a nitroimidazole. [33]  See ACG Guidelines.

In the United States, PPI–based triple therapy was the previous recommendation. [1] These regimens result in a cure of infection and ulcer healing in approximately 85-90% of cases. [2] Ulcers can recur in the absence of successful H pylori eradication.

Dual therapies, which are alternative regimens for treating H pylori infection, are usually not recommended as first-line therapy, because of a variable cure rate that is significantly less than the cure rate achieved with triple therapy.

Spouses and H pylori –positive family members of H pylori –positive persons should be considered for testing and treatment of H pylori infection, [54] since mother-to-child transmission may be a major route of H pylori infection. [55]

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