A review published in Current Treatment Options in Gastroenterology summarizes three recently published guidelines on the management of Helicobacter pylori: the Toronto consensus statement, the Maastricht V/Florence consensus report, and the American College of Gastroenterology guidelines on H. pylori

Study authors David J. Bjorkman and Matthew Steenblik, from the University of Utah School of Medicine, Salt Lake City, UT, compared and contrasted the recommendations and offered a best practice approach for integrating the three guidelines. 

With regards to treatment approach, the authors recommend antibiotic selection be based on local and individual resistance patterns, as the efficacy of previously established treatment regimens for H. pylori have diminished over time with increasing antibiotic resistance. A 14-day course of bismuth- or antibiotic-based quadruple therapy should be considered first-line treatment, while triple therapy with clarithromycin should not be used unless the local resistance rate is <15%. Second-line therapy, such as quadruple bismuth-based therapy or levofloxacin-based therapy, can be considered when first-line therapy has failed. In addition, antibiotic resistance testing is recommended after multiple treatment failures. 

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“Additional efforts are needed to define local antibiotic resistance to allow susceptibility-based treatment.  In the meantime, 14-day quadruple therapy with bismuth or concomitant antibiotics is recommended as an empiric first-line treatment approach,” conclude the authors.

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