Fast Five Quiz: Management of Helicobacter pylori

Steven F. Moss, MD; Cristian Puerta, MD


October 18, 2023

In clinical practice, first-line therapy generally offers the best likelihood of treatment success. Therefore, careful attention to the selection of the optimal first-line eradication therapy for an individual patient is crucial. Antimicrobial resistance in H pylori is a major concern and often the cause of eradication failure. Consequently, tailored therapy, on the basis of antimicrobial susceptibility test results, by culture or rapid polymerase chain reaction testing, is considered the gold standard in the use of recommended treatment regimens, according to current World Gastroenterology Organization Global guidelines.

Triple therapy, which typically includes a proton pump inhibitor (PPI) with amoxicillin and clarithromycin, remains the most commonly used first-line therapy in most parts of the world.

Sequential therapy comprising a PPI and amoxicillin for 5 days followed by a PPI, clarithromycin, and a nitroimidazole for 5 days has been proposed as an alternative to standard triple therapy.

Previous macrolide exposure has been shown to be a significant consideration when selecting a first-line treatment regimen for patients with H pylori infection owing to concerns about antibiotic resistance. According to the current World Gastroenterology Organization Global guideline, "first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole is recommended as first-line therapy in most areas" for this population.

Learn more about the management of H pylori infection.


Comments on Medscape are moderated and should be professional in tone and on topic. You must declare any conflicts of interest related to your comments and responses. Please see our Commenting Guide for further information. We reserve the right to remove posts at our sole discretion.