Duration of therapy for first-line H. pylori eradication therapy in adults

The optimal duration of therapy for H. pylori eradication is controversial, and depends primarily on the likelihood of antibiotic resistance, which varies around the world. International recommendations range from 7 to 14 days. A Cochrane review¹ found increased success rates with 14 days of therapy.

Reported primary clarithromycin resistance in Australia historically ranged from about 6 to 8%; however, recent local antimicrobial resistance data are limited and it is unclear whether they can be generalised to all of AustraliaSchubert, 2021. Given the limited local resistance data and clinical trials to guide the duration of H. pylori eradication therapy, the duration of therapy should be individualised—consider:

• local resistance patterns (if known)
• the risk of clarithromycin resistance in the patient, which depends on various factors, including:
  • previous clarithromycin therapy (for any indication)—this increases the likelihood of secondary resistance and treatment failure
  • current or previous residence in a country where resistance to clarithromycin is high
• tolerability.