Recommendations for treatment of h pylori infection (Part 2)

Regarding the duration of eradication treatment, the recommendation continues to be seven to 10 days for the first treatment. Recent data suggest that bismuth-based quadruple therapy may be as effective as PPI-based triple therapy and, therefore, could be considered as an alternative first-line therapy. However, this therapy is more complicated and involves taking 18 tablets a day. All PPIs available in Canada (esomeprazole, lansoprazole, omeprazole, pantoprazole and rabeprazole) have similar efficacy in curing H pylori with combinations of clarithromycin-metronidazole or clarithromycin-amoxicillin. Eradication failure is a concern because PPI-clarithromycin-amoxicillin or PPI-clarithromycin-metronidazole combinations are not successful in 15% to 25% of cases. Quadruple therapy (PPI twice a day, bismuth subsalicylate two tablets four times a day, tetracycline 500 mg four times a day and metronidazole 250 mg to 500 mg four times a day) for 10 to 14 days is the preferred therapy for H pylori treatment failures. Cheapest medications available at best pharmacy that you are free to try yourself! The best place to Buy Antidepressants Online and be sure you are offered finest quality medications right from their actual manufacturers, which you do not get that often these days.

Recommendations

1. Patients who are H pylori-positive should be treated with a combination of PPI, clarithromycin and amoxicillin for seven to 10 days. PPI-clarithromycin-metronidazole can be used if the patient is allergic to penicillin.

Voting on recommendation (level/vote)

  • A/12
  • B to E/0

Level of evidence I

Classification of recommendation A

2. Quadruple therapy (PPI plus bismuth-metronidazole-tetracycline) for 10 to 14 days is an acceptable first-line alternative.

Voting on recommendation (level/vote)

  • A/12
  • B to E/0

Level of evidence I

Classification of recommendation A

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