Table 2.

Recommendations for the Treatment of Helicobacter pylori

Category	Statements	Level of evidences	Strength of recommendation
Indications	1. H. pylori eradication can be helpful to improve the anemia in subset of adults with unexplained iron deficiency anemia.	Very low	Weak
	2. H. pylori eradication can be recommended after endoscopic resection for H. pylori-positive gastric adenoma to prevent metachronous recurrence.	Low	Weak
	3. H. pylori eradication can be recommended for long-term improvement of dyspeptic symptoms in patients with functional dyspepsia.	High	Weak
First-line therapy	4. Standard triple therapy (standard dose PPI, amoxicillin 1 g, and clarithromycin 500 mg twice daily) for 14 days is recommended for first-line regimen.	Moderate	Strong
	5. Sequential therapy (standard dose PPI, amoxicillin 1 g twice daily for 5 days followed by standard dose PPI, clarithromycin 500 mg, and metronidazole 500 mg twice daily for 5 days) can be one of first-line therapies for H. pylori eradication.	High	Strong
	6. Concomitant therapy (standard dose PPI, clarithromycin 500 mg, amoxicillin 1 g, and metronidazole 500 mg twice daily for 10 days) is recommended as a first-line treatment.	High	Strong
	7. Clarithromycin resistance test by PCR or sequencing is recommended when a 7-day standard triple therapy is considered as a first-line treatment.	Low	Strong
	8. Eradication rates of bismuth quadruple therapy (standard dose PPI twice daily, metronidazole 500 mg three times daily, bismuth 120 mg and tetracycline 500 mg four times daily for 10 to 14 days) are similar to 14 days standard triple therapy, 10 days concomitant therapy, and 10 days sequential therapy. However, because of its high adverse effects and potential use as second-line therapy, it can be recommended to be used as first-line therapy if other first-line therapy options are not available.	Moderate	Weak
Salvage therapy	9. After failure of standard triple therapy, a bismuths quadruple therapy (PPI, bismuth, tetracycline, and metronidazole) for 14 days is recommended as a second-line therapy.	High	Strong
	10. After failure of non-bismuth quadruple therapy (sequential or concomitant therapy), a bismuth quadruple therapy is recommended as a second-line therapy.	Very low	Strong
	11. After failure of bismuth quadruple therapy as 1st-line or 2nd-line therapy (after failed standard triple or non-bismuth quadruple therapy), a levofloxacin triple therapy is suggested as a salvage therapy.	Very low	Weak

PPI, proton pump inhibitor; PCR, polymerase chain reaction.