A 37-year-old man has recurrent epigastric pain that improves with meals. He takes no NSAIDs. Urea breath test is positive for Helicobacter pylori.

Question

A 37-year-old man has recurrent epigastric pain that improves with meals. He takes no NSAIDs. Urea breath test is positive for Helicobacter pylori. Local clarithromycin resistance is high. He has no drug allergies. Which of the following is the most appropriate next step in management?

Accepted Answer

Treat with bismuth quadruple therapy

Answer

Give proton pump inhibitor monotherapy

Answer

Treat with metronidazole alone

Answer

Use clarithromycin triple therapy without susceptibility data

Answer

Schedule gastrectomy

Helicobacter pylori infection — USMLE Step 3 MCQ

A 37-year-old man has recurrent epigastric pain that improves with meals. He takes no NSAIDs. Urea breath test is positive for Helicobacter pylori. Local clarithromycin resistance is high. He has no drug allergies. Which of the following is the most appropriate next step in management?