H. pylori Treatment Decision Tool
Has the patient been previously treated for H. pylori?
Important factors:
- Verification of H. pylori eradication 2 weeks post-antibiotic therapy can be performed through a urea breath test, stool antigen test, or testing during upper endoscopy. Serological tests are not recommended for confirming H. pylori eradication.
- In instances of H. pylori persistence, culture and susceptibility testing should guide antibiotic selection. If such testing is not feasible, opt for a Rifabutin-based triple therapy or an alternate rescue regimen.
- Employ a levofloxacin-sensitive regimen if the strain is known to be susceptible or if the prevalence of resistance to levofloxacin in the population is below 15%.
- Macrolide-resistant strains, specifically those resistant to clarithromycin, should be treated with alternative regimens unless the patient has no prior exposure to macrolides and the local resistance rate to clarithromycin is less than 15%. Avoid this approach if local resistance patterns are not well-established.