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H. pylori Infection — ABIM Board MCQ

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EasyGastroenterologyH. pylori InfectionABIM Board

A 44-year-old patient with peptic ulcer disease has a positive urea breath test for Helicobacter pylori. The patient has not previously received H. pylori eradication therapy, and antibiotic susceptibility results are unavailable. Which regimen is preferred as empiric initial therapy in the United States?

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Correct answer: D — Bismuth quadruple therapy for 14 days

Bismuth quadruple therapy for 14 days is the preferred empiric initial regimen for a treatment-naive patient when antibiotic susceptibility is unknown. It combines acid suppression, bismuth, tetracycline, and metronidazole and avoids reliance on clarithromycin or levofloxacin susceptibility. Clarithromycin- and levofloxacin-based regimens should generally be reserved for infections shown to be susceptible because resistance can substantially reduce eradication rates. Concomitant therapy contains clarithromycin and is not the preferred empiric regimen in the current ACG guideline, although it has been used historically. Amoxicillin alone does not provide an adequate eradication regimen.

Reference: American College of Gastroenterology: Chey WD, et al. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Treatment-naive recommendation. Am J Gastroenterol. 2024;119(9):1730-1753. https://pubmed.ncbi.nlm.nih.gov/39626064/