Guidelines for the salvage therapy: Difference between revisions

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==2017 ACG Guidelines for first-line treatment strategies of peptic ulcer disease for providers in North America==
==2017 ACG Guidelines for first-line treatment strategies of peptic ulcer disease for providers in North America==
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| colspan="1" style="text-align:center; background:LightGreen" |Strong recommendation
| colspan="1" style="text-align:center; background:LightGreen" |Strong recommendation
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| bgcolor="LightGreen" |1.Bismuth quadruple therapy consisting of a PPI, bismuth, tetracycline, and a nitroimidazole for 10–14 days is a recommended fi rst-line treatment option.
| bgcolor="LightGreen" |In patients with persistent H. pylori infection, every effort should be made to avoid antibiotics that have been previously taken by the patient
Bismuth quadruple therapy is particularly attractive in patients with any previous macrolide exposure or who are allergic to penicillin


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| bgcolor="LightGreen" |2.Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days is a recommended fi rst-line treatment option
| bgcolor="LightGreen" |The following regimens can be considered for use as salvage treatment:
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1.Bismuth quadruple therapy for 14 days is a recommended salvage regimen.
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| bgcolor="LightGreen" |2.Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days is a recommended fi rst-line treatment option
2.Levofl oxacin triple regimen for 14 days is a recommended salvage regimen
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| bgcolor="LightGreen" |2.Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days is a recommended fi rst-line treatment option
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| bgcolor="LightGreen" |2.Concomitant therapy consisting of a PPI, clarithromycin, amoxicillin and a nitroimidazole for 10–14 days is a recommended fi rst-line treatment option
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| colspan="1" style="text-align:center; background:LemonChiffon" |Conditional recommendation
| colspan="1" style="text-align:center; background:LemonChiffon" |Conditional recommendation
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| bgcolor="LemonChiffon" |'''1.'''Patients should be asked about any previous antibiotic exposure(s) and this information should be taken into consideration when choosing an H. pylori
| bgcolor="LemonChiffon" |Bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options if a patient received afirstt-line treatment containing
treatment regimen '''.'''
clarithromycin. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics
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| bgcolor="LemonChiffon" |2.Clarithromycin triple therapy consisting of a PPI, clarithromycin, and amoxicillin or metronidazole for 14 days remains a recommended treatment in regions
| bgcolor="LemonChiffon" |Clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options, if a patient received first-line bismuth quadruple therapy.
where H. pylori clarithromycin resistance is known to be <15% and in patients with no previous history of macrolide exposure for any reason.
Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics
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| bgcolor="LemonChiffon" |3.Sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, clarithromycin, and a nitroimidazole for 5–7 days is a suggested first line
| bgcolor="LemonChiffon" |The following regimens can be considered for use as salvage treatment:
1.Concomitant therapy for 10–14 days is a suggested salvage regimen.


treatment option.
2.Clarithromycin triple therapy should be avoided as a salvage regimen.  


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3.Rifabutin triple regimen consisting of a PPI, amoxicillin, and rifabutin for 10 days is a suggested salvage regimen.
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| bgcolor="LemonChiffon" |4.Hybrid therapy consisting of a PPI and amoxicillin for 7 days followed by a PPI, amoxicillin, clarithromycin and a nitroimidazole for 7 days is a suggested
High-dose dual therapy consisting of a PPI and amoxicillin for 14 days is a suggested salvage regimen.


first-line treatment option.
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| bgcolor="LemonChiffon" |5.Levofloxacin triple therapy consisting of a PPI, levofloxacin, and amoxicillin for 10–14 days is a suggested first-line treatment option.
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| bgcolor="LemonChiffon" |6.Fluoroquinolone sequential therapy consisting of a PPI and amoxicillin for 5–7 days followed by a PPI, fluoroquinolone, and nitroimidazole for 5–7 days is a
suggested first-line treatment option.
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Revision as of 20:06, 1 December 2017


Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Manpreet Kaur, MD [2], Sargun Singh Walia M.B.B.S.[3]

2017 ACG Guidelines for first-line treatment strategies of peptic ulcer disease for providers in North America

Strong recommendation
In patients with persistent H. pylori infection, every effort should be made to avoid antibiotics that have been previously taken by the patient
The following regimens can be considered for use as salvage treatment:

1.Bismuth quadruple therapy for 14 days is a recommended salvage regimen.

2.Levofl oxacin triple regimen for 14 days is a recommended salvage regimen

Conditional recommendation
Bismuth quadruple therapy or levofl oxacin salvage regimens are the preferred treatment options if a patient received afirstt-line treatment containing

clarithromycin. Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics

Clarithromycin or levofloxacin-containing salvage regimens are the preferred treatment options, if a patient received first-line bismuth quadruple therapy.

Selection of best salvage regimen should be directed by local antimicrobial resistance data and the patient’s previous exposure to antibiotics

The following regimens can be considered for use as salvage treatment:

1.Concomitant therapy for 10–14 days is a suggested salvage regimen.

2.Clarithromycin triple therapy should be avoided as a salvage regimen.

3.Rifabutin triple regimen consisting of a PPI, amoxicillin, and rifabutin for 10 days is a suggested salvage regimen.

High-dose dual therapy consisting of a PPI and amoxicillin for 14 days is a suggested salvage regimen.

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