GASTROENTEROLOGY ARTICLE OF THE WEEK
January 29, 2009
Saad RJ, Chey WD. Persistent Helicobacter pylori infection after a course of antimicrobial therapy – What’s next? Clin Gastroenterol Hepatol 2008;6:1080-1090
1. When designing a salvage regimen for H pylori you should:
a. Try the same regimen again, in case compliance was an issue
b. Give the salvage regimen for at least 10-14 days, not less
c. Do not use clarithromycin again if it was used in the first regimen
d. Strongly consider obtaining H pylori
culture and sensitivity prior to designing the salvage regimen
True or False
2. Quadruple
therapy (bismuth, tetracycline, metronidazole, PPI) can be effective in
patients with clarithromycin or metronidazole-resistant H pylori
3. Baseline H pylori clarithromycin resistance in the U.S. is 10-13%, the efficacy of clarithromycin-containing eradication regimen is < 30% in the presence of resistance
4. Increasing the dose of clarithromycin to 1,000mg bid can overcome H. pylori resistance
5. The most
common regimen used to treat H. pylori resistant to
amoxicillin-clarythromycin-PPI is quadruple therapy with
bismuth-tetracycline-metronidazole-PPI
6. H pylori
resistance to metronidazole can be overcome by using higher dose of
metronidazole in combination with a PPI.
7. All patients with Helicobacter-related PUD who undergo H pylori eradication should be undergo testing to confirm cure a minimum of 4 weeks after completing therapy
8. While 7-day
regimens may be acceptable, it is generally agreed that 10 or 14 day courses of
therapy are more effective.