From the Guidelines
Treatment of H. pylori infection during pregnancy should generally be deferred until after delivery unless absolutely necessary due to severe symptoms or complications. If treatment is required, the decision to treat must balance the risks of medication against the benefits of treating the infection, considering that H. pylori is typically a chronic infection that rarely causes acute complications 1. The preferred regimen is not explicitly stated in the provided evidence for pregnancy, but considering the general principles of H. pylori treatment and the need for caution with medication use during pregnancy, a regimen that is often considered relatively safe is amoxicillin plus metronidazole with a proton pump inhibitor (PPI), given the extensive safety data for amoxicillin and the acceptance of metronidazole after the first trimester 2, 3. However, the most recent and highest quality study suggests that quadruple therapies, including bismuth quadruple therapy, are becoming the standard for initial H. pylori treatment due to increasing antibiotic resistance 1. Key considerations include:
- Avoiding clarithromycin, tetracyclines, and fluoroquinolones due to potential fetal risks.
- Confirming H. pylori infection through non-invasive testing before initiating treatment.
- Weighing the benefits of treating the infection against the risks of medication use during pregnancy. Given the evolving nature of antibiotic resistance and treatment guidelines, it is crucial to consult the most recent clinical guidelines and consider the specific circumstances of each patient, including the severity of symptoms, the trimester of pregnancy, and local resistance patterns 1, 3.
From the Research
H pylori Treatment in Pregnancy
- The treatment of H pylori infection in pregnancy is crucial to prevent complications such as gastritis, gastric and duodenal ulcers, and gastric cancer 4.
- First-line therapy for H pylori infection includes clarithromycin triple therapy, bismuth quadruple therapy, or concomitant therapy, but the choice of treatment may be limited in pregnant women due to potential contraindications to certain antibiotics 4.
- There is limited information on the safety and efficacy of H pylori treatment in pregnancy, and the choice of treatment should be individualized based on the patient's medical history and the potential risks and benefits of each treatment option.
- Some studies suggest that metronidazole, omeprazole, and clarithromycin may be an effective combination therapy for H pylori infection, but the safety of this regimen in pregnancy is not well established 5.
- Bismuth quadruple therapy is recommended as the best initial empiric treatment for H pylori infection, but its safety and efficacy in pregnancy are not well studied 6.
- The use of probiotics may improve the tolerability of H pylori eradication regimens, but further studies are needed to confirm this 6.
- Susceptibility-guided treatment appears to be the ideal approach to eradicate H pylori, but the feasibility and cost-effectiveness of universal pre-treatment susceptibility testing need to be evaluated further 6.