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Pharmacotherapy. 2019 Aug 10. doi: 10.1002/phar.2318. [Epub ahead of print]

Treatment of Helicobacter pylori in Special Patient Populations.

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Department of Pharmacy, University of Chicago Medicine, Chicago, Illinois.
Department of Pharmacy, Wake Forest Baptist Medical Center, Winston Salem, North Carolina.
School of Pharmacy, Wingate University, Wingate, North Carolina.
Department of Pharmacy, Southeast Louisiana Veteran Health Care System, New Orleans, Louisiana.


Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First-line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second-line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first- and second-line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc-interval prolongation, and patients who are pregnant, breastfeeding, or elderly.


Helicobacter pylori ; QT prolongation; breastfeeding; elderly; hypersensitivity; pregnancy


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