The 6th Edition Maastricht/Florence Consensus 2021 report covers advances in the management of Helicobacter pylori (Hp) infection, providing guidance on the management of Hp infection and recommending
eradication therapies for treatment of Hp infection.
Click to view details: Which eradication therapies are recommended by the Ma Liu Consensus? Management of Helicobacter pylori infection - Maastricht VI/Florence Consensus Report Released!
The consensus states that hp is empirically eradicated if individual antibiotic susceptibility tests are not possible
The following is a flowchart of empiric eradication hp therapy:
Bismuth quadruple therapy: proton pump inhibitors (PPIs), bismuth agents, tetracycline, and metronidazole
Clarithromycin triple therapy: PPI, clarithromycin, and amoxicillin (used only when locally proven effective or known sensitivity to clarithromycin) non-bismuth quadruple therapy (with accompaniment) :P PI, clarithromycin, amoxicillin, and metronidazole
Levofloxacin tetratherapy: PPI, levofloxacin, amoxicillin, and bismuth.
Levofloxacin triple therapy: same as above, but without bismuth
In the case of high fluoroquinolone resistance (> 15%), bismuth may be selected in combination with other antibiotics or high-dose PPI-amoxicillin diptych or rifabutin
*High dose PPI or potassium ion competitive acid blocker (P-CAB) (vonoracin, if available) plus amoxicillin may be used as an alternative
References: Malfertheiner P, Megraud F, Rokkas T, et al.
Management of Helicobacter pylori infection: the Maastricht VI/Florence consensus report[J].
Gut, 2022, 71(9): 1724-1762.