Helicobacter pylori — ESEGH MCQ
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Correct answer: B — Bismuth quadruple therapy (PPI, bismuth salt, metronidazole, tetracycline) for 14 days
Bismuth quadruple therapy for 14 days (B) is the evidence-based first-line choice. Current international consensus (2016 Toronto, Maastricht V/VI, European Helicobacter Study Group, Irish 2017) recommends 14-day quadruple therapy (bismuth or non-bismuth concomitant) as standard first-line eradication. Standard clarithromycin triple therapy (A) is no longer recommended because rising clarithromycin resistance has reduced efficacy below 90%. Although outdated UK primary care guidance permits 7-day clarithromycin triple therapy, this fails to meet contemporary consensus standards for specialist practice. Option A's 10-day duration is suboptimal compared with the evidence-supported 14 days. Fluoroquinolones (C) are second-line agents, not first-line, reserved for clarithromycin-resistant strains. Dual therapy (D) is inadequate; all guidelines require minimum triple therapy. Monotherapy (E) has no role. For a specialist trainee, bismuth quadruple therapy for 14 days represents the current standard of care aligned with international consensus and supported by eradication rates exceeding 90%.
Reference: European Registry on Helicobacter pylori Management (Hp-EuReg) 2017 Irish Consensus & 2016 Toronto Helicobacter pylori Consensus Recommendations, supplemented by BSG education and contemporary literature (Malfertheiner et al. Maastricht V/Florence; Canadian Association of Gastroenterology 2016); https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12291691/ ; https://www.ncbi.nlm.nih.gov/pmc/articles/PMC11149661/