Treatment of Helicobacter pylori Infection


William D. Chey, MD, FACG1, Grigorios I. Leontiadis, MD, PhD2, Colin W. Howden, MD, FACG3, and Steven F. Moss, MD, FACG4

1Division of Gastroenterology, University of Michigan Health System, Ann Arbor, Michigan, USA; 2Division of Gastroenterology, McMaster University, Hamilton, Ontario, Canada; 3Division of Gastroenterology, University of Tennessee Health Science Center, Memphis, Tennessee, USA; and 4Division of Gastroenterology, Warren
Alpert Medical School of Brown University, Providence, Rhode Island, USA

Helicobacter pylori (H. pylori) infection is a common worldwide infection that is an important cause of peptic ulcer disease and gastric cancer. H. pylori may also have a role in uninvestigated and functional dyspepsia, ulcer risk in patients taking low-dose aspirin or starting therapy with a non-steroidal anti-inflammatory medication, unexplained iron deficiency anemia, and idiopathic thrombocytopenic purpura. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. For first-line treatment, clarithromycin triple therapy should be confined to patients with no previous history of macrolide exposure who reside in areas where clarithromycin resistance amongst H. pylori isolates is known to be low. Most patients will be better served by first-line treatment with bismuth quadruple therapy or concomitant therapy consisting of a PPI, clarithromycin, amoxicillin, and metronidazole. When first-line therapy fails, a salvage regimen should avoid antibiotics that were previously used. If a patient received a first-line treatment containing clarithromycin, bismuth quadruple therapy or levofloxacin salvage regimens are the preferred treatment options. If a patient received first-line bismuth quadruple therapy, clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options. Details regarding the drugs, doses and durations of the recommended and suggested first-line and salvage regimens can be found in the guideline.

Am J Gastroenterol 2017;112:212-238
Received 28 June 2016 ; accepted 7 October 2016.

Correspondence: William D. Chey, MD, FACG, Timothy T. Nostrant Professor of Gastroenterology and Nutrition Sciences, Division of Gastroenterology, University of Michigan Health System, 3912 Taubman Center, SPC 5362, Ann Arbor, Michigan 49109-5362, USA. E-mail: