HP infection is a common cause of peptic ulcer disease and gastric cancer. When choosing treatment for HP infection, a patient's previous antibiotic exposure should be considered to determine the most effective regimen. For first-line treatment, clarithromycin triple therapy should only be used in areas with low clarithromycin resistance and in patients without prior macrolide exposure. Bismuth quadruple therapy or concomitant therapy with a PPI, clarithromycin, amoxicillin and metronidazole are better first-line options for most patients. Salvage regimens after first-line treatment failure should avoid previously used antibiotics and may include bismuth quadruple therapy or levofloxacin depending

1. Dr.Hero Ismael
MBChB- FICMS-Int Med- Kurdistan Board
GEH.
Consultant gastroenterologist & hepatologist

2. Introduction:Introduction:
 HP infection is a common worldwide infection that is anHP infection is a common worldwide infection that is an
important cause of PUD& gastric cancer.important cause of PUD& gastric cancer.
 H. pylori may also have a role in uninvestigated / functionalH. pylori may also have a role in uninvestigated / functional
dyspepsia, ulcer risk with low-dose aspirin or NSAIDs,dyspepsia, ulcer risk with low-dose aspirin or NSAIDs,
unexplained IDA&ITP.unexplained IDA&ITP.
 While choosing a treatment regimen for H. pylori , patientsWhile choosing a treatment regimen for H. pylori , patients
should be asked about previous antibiotic exposure &should be asked about previous antibiotic exposure &
incorporated into the decision-making process.incorporated into the decision-making process.
 For first-line treatment, clarithromycin triple therapy should beFor first-line treatment, clarithromycin triple therapy should be
confined to patients with no previous H/O macrolide exposureconfined to patients with no previous H/O macrolide exposure
who reside in areas where clarithromycin resistance is known to bewho reside in areas where clarithromycin resistance is known to be
low.low.
 Most patients will be better served by first-line treatment withMost patients will be better served by first-line treatment with
bismuth quadruple therapy or concomitant therapy consisting of abismuth quadruple therapy or concomitant therapy consisting of a
PPI, clarithromycin, amoxicillin&metronidazole.PPI, clarithromycin, amoxicillin&metronidazole.

3. Introduction:Introduction:
 When first-line therapy fails, a salvage regimen should avoidWhen first-line therapy fails, a salvage regimen should avoid
antibiotics that were previously used.antibiotics that were previously used.
 If a patient received a first-line treatment containingIf a patient received a first-line treatment containing
clarithromycin, bismuth quadruple therapy or levofloxacin salvageclarithromycin, bismuth quadruple therapy or levofloxacin salvage
regimens are the preferred treatment options.regimens are the preferred treatment options.
 If a patient received first-line bismuth quadruple therapy,If a patient received first-line bismuth quadruple therapy,
clarithromycin or levofl oxacin-containing salvage regimens areclarithromycin or levofl oxacin-containing salvage regimens are
the preferred treatment options.the preferred treatment options.