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aDepartment of Clinical Medicine, School of Medicine bSchool of Pharmacy and Pharmaceutical Sciences, Trinity College Dublin cDepartment of Clinical Microbiology dDepartment of Gastroenterology, St James's Hospital eDepartment of Histopathology fDepartment of Gastroenterology, Adelaide and Meath Hospital gDepartment of Gastroenterology, Royal College Surgeons in Ireland, Connolly Hospital hDepartment of Gastroenterology, Beacon Clinic, Dublin iDepartment of Gastroenterology, Mercy University Hospital, Cork jDepartment of Microbiology, University Hospital Waterford kDepartment of Gastroenterology, Whitfield Clinic, Waterford, Ireland lDepartment of Gastroenterology, Hepatology and Infectious Diseases, Otto-von-Guericke University of Magdeburg, Magdeburg, Germany mDepartment of Bacteriology nINSERM U1053, University of Bordeaux, Bordeaux, France.
Published: May 2017
AI Article Synopsis
Article Abstract
Background: Irish eradication rates for Helicobacter pylori are decreasing and there is an increase in the prevalence of antibiotic-resistant bacteria. These trends call into question current management strategies.
Objective: To establish an Irish Helicobacter pylori Working Group (IHPWG) to assess, revise and tailor current available recommendations.
Methods: Experts in the areas of gastroenterology and microbiology were invited to join the IHPWG. Questions of relevance to diagnosis, first-line and rescue therapy were developed using the PICO system. A literature search was performed. The 'Grading of Recommendations Assessment, Development and Evaluation' approach was then used to rate the quality of available evidence and grade the resulting recommendations.
Results: Key resultant IHPWG statements (S), the strength of recommendation and quality of evidence include S8: standard triple therapy for 7 days' duration can no longer be recommended (strong and moderate). S9: 14 days of clarithromycin-based triple therapy with a high-dose proton pump inhibitor (PPI) is recommended as first-line therapy. Bismuth quadruple therapy for 14 days is an alternative if available (strong and moderate). S12: second-line therapy depends on the first-line treatment and should not be the same treatment. The options are (a) 14 days of levofloxacin-based therapy with high-dose PPI, (b) 14 days of clarithromycin-based triple therapy with high-dose PPI or (c) bismuth quadruple therapy for 14 days (strong and moderate). S13: culture and antimicrobial susceptibility testing should be performed following two treatment failures (weak and low/very low).
Conclusion: These recommendations are intended to provide the most relevant current best-practice guidelines for the management of H. pylori infection in adults in Ireland.
