What are the College of Gastroenterology (ACOG) treatment guidelines for H pylori infection?

Updated: May 21, 2019
  • Author: Elwyn C Cabebe, MD; Chief Editor: N Joseph Espat, MD, MS, FACS  more...
  • Print
Answer

The 2017 ACOG guidelines include the following recommendations [64] :

  • Evidence that eradication of H pylori infection reverses the gastric premalignant changes of gastric atrophy and intestinal metaplasia is conflicting. 

  • Testing for H pylori infection is indicated in all patients with active peptic ulcer disease, a past history of documented peptic ulcer,low-grade gastric mucosa-associated lymphoid tissue (MALT) lymphoma, or a history of endoscopic resection of early gastric cancer; testing may  be considered in patients with uninvestigated dyspepsia who are younger than 60 years and do not have alarm features (non-endoscopic testing)

In North America, triple therapy with a proton pump inhibitor (PPI), clarithromycin, and amoxicillin or metronidazole for 14 days remains a recommended treatment option in areas where H pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure for any reason. Other recommended first-line treatment regimens are as follows:

  • Bismuth quadruple therapy with a PPI, bismuth, tetracycline, and a nitroimidazole for 10–14 days, especially in patients with any previous macrolide exposure or penicillin allergy
  • Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days

Suggested first-line treatment regimens are as follows:

  • Sequential therapy with a PPI and amoxicillin for 5–7 days followed by a PPI, clarithromycin, and a nitroimidazole for 5–7 days 
  • Hybrid therapy with a PPI and amoxicillin for 7 days followed by a PPI, amoxicillin, clarithromycin and a nitroimidazole for 7 days 
  • Levofloxacin triple therapy with a PPI, levofloxacin, and amoxicillin for 10–14 days 
  • Fluoroquinolone sequential therapy with a PPI and amoxicillin for 5–7 days followed by a PPI, fluoroquinolone, and nitroimidazole for 5–7 days 

Did this answer your question?
Additional feedback? (Optional)
Thank you for your feedback!