Treatment of Helicobacter pylori Infection

Guideline title ACG Clinical Guideline: Treatment of Helicobacter pylori Infection

Release date September 2024

Prior version 2017

Developer American College of Gastroenterology (ACG)

Target population Outpatients aged 18 years or older with H pylori infection, with recommendations prioritized for persons residing in North America

Selected recommendations

For treatment-naive patients with H pylori infection, bismuth quadruple therapy (BQT) for 14 days is recommended as first-line treatment (strong recommendation; moderate quality of evidence [QOE]). When BQT is not an option, rifabutin triple therapy (conditional recommendation; low QOE) or potassium-competitive acid blocker (PCAB; eg, vonoprazan) dual therapy (conditional recommendation; moderate QOE) are suggested.

For treatment-naive patients with H pylori, empirical use of regimens containing clarithromycin is not recommended. However, if no first-line treatment is available, PCAB triple therapy is suggested over proton pump inhibitor (PPI) triple therapy (conditional recommendation; moderate QOE).

For patients with persistent H pylori infection who received PPI triple therapy rather than BQT, BQT is suggested (conditional recommendation; low QOE).

For patients with persistent H pylori infection who have received BQT, rifabutin triple therapy is suggested (conditional recommendation; low QOE).