Hp infection treatment 

Statement 17: The cure rate threshold for first-line protocols for sensitive strains should be at least 95% of patients cured according to the protocol set analysis (PP), and the intentional treatment analysis (ITT) cure rate threshold should be 90% or higher. (Level of evidence: high; recommended level: strong)

Statement 18: Amoxicillin and tetracycline are low and stable. Metronidazole resistance is generally higher in ASEAN countries. The resistance of clarithromycin has been increasing in many areas and has reduced the eradication rate of standard triple therapy. (Level of evidence: high; recommended level: N/A)

Statement 19: When the resistance rate of clarithromycin is 10% to 15%, it is considered to be a high rate of resistance, and the area is divided into a high-resistance area and a low-resistance area. (Level of Evidence: Medium; Recommended Level: N/A)

Statement 20: For most therapies, the 14d course is optimal and should be used. A shorter course of treatment can only be accepted if it has been proven to reliably achieve a 95% cure rate threshold by PP or a 90% cure rate threshold by ITT analysis. (Level of evidence: high; recommended level: strong)

Statement 21: The choice of recommended first-line treatment options varies by region, geographic location, and antibiotic resistance patterns known or expected by individualized patients. (Level of evidence: high; recommended level: strong)

Statement 22: The second-line treatment regimen should include antibiotics that have not been used before, such as amoxicillin, tetracycline, or antibiotics that have not increased resistance. (Level of evidence: high; recommended level: strong)

Statement 23: The primary indication for antibiotic drug susceptibility testing is to perform sensitivity-based treatments, which are currently performed after failure of second-line therapy. (Level of evidence: high; recommended rating: strong) 

Statement 24: Where possible, remedial treatment should be based on a sensitivity test. If susceptibility testing is not possible, drugs with universal drug resistance should not be included, and drugs with low drug resistance should be used. (Level of evidence: high; recommended rating: strong)

Statement 25: A method for increasing the Hp eradication rate by increasing the antisecretory effect of PPI requires a host-based CYP2C19 genotype, either by increasing the high metabolic PPI dose or by using a PPI that is less affected by CYP2C19. (Level of evidence: high; recommended rating: strong)

Statement 26: In the presence of metronidazole resistance, increasing the dose of metronidazole to 1500 mg/d or more and extending the treatment time to 14 days will increase the cure rate of the quadruple therapy with expectorant. (Level of evidence: high; recommended rating: strong)

Statement 27: Probiotics can be used as an adjunctive therapy to reduce adverse reactions and improve tolerance. The use of probiotics plus standard treatment may result in an appropriate increase in eradication rates. However, these benefits have not been shown to be cost effective. (Level of evidence: high; recommended rating: weak)

Statement 28: A common solution for patients who are allergic to penicillin is the use of a quadruple therapy with expectorant. Other options depend on the local susceptibility pattern. (Level of evidence: high; recommended rating: strong)

Statement 29: The annual reinfection rate of Hp reported by ASEAN countries is 0-6.4%. (Level of evidence: medium) 

Statement 30: Hp-related dyspepsia is identifiable. In patients with dyspepsia with Hp infection, if the symptoms of dyspepsia are relieved after Hp is successfully eradicated, these symptoms can be attributed to Hp infection. (Level of evidence: high; recommended rating: strong)

Follow-up

Statement 31:31a: A non-invasive examination is recommended to confirm whether Hp is eradicated in patients with duodenal ulcer.

                    31b: Normally, at 8 to 12 weeks, a gastroscopy is recommended for patients with gastric ulcer to record the complete healing of the ulcer. In addition, when the ulcer does not heal, a biopsy of the gastric mucosa is recommended to rule out the malignancy. (Level of evidence: high; recommended rating: strong)

Statement 32: Early gastric cancer and patients with gastric MALT lymphoma with Hp infection must confirm whether Hp is successfully eradicated at least 4 weeks after treatment. Follow-up endoscopy is recommended. (Level of evidence: high; recommended rating: strong)