Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report

Syam, Ari Fahrial; Miftahussurur, Muhammad; Makmun, Dadang; Abdullah, Murdani; Rani, Abdul Aziz; Siregar, Gontar Alamsyah; Simadibrata, Marcellus; Zubir, Nasrul; Dewa Nyoman Wibawa, I.; Purnomo, Hery Djagat; Manan, Chudahman; Djojoningrat, Dharmika; Fauzi, Achmad; Renaldi, Kaka; Maulahela, Hasan; Utari, Amanda Pitarini; Pribadi, Rabbinu Rangga; Muzellina, Virly Nanda; Nursyirwan, Saskia Aziza; Idrus, Muhammad Firhat; Ruswhandi, Ruswhandi; Sugihartono, Titong; Bestari, Muhammad Begawan; Bayupurnama, Putut; Pramana, Triyanta Yuli; Wibowo, Bogi Pratomo; Bakry, Achmad Fuad; Akil, Fardah; Parewangi, Andi Muhammad Luthfi; Widita, Haris; Mariadi, I Ketut; Murti, Ignatia Sinta; Yusuf, Ali Imron; Arles, Arles; Yusuf, Fauzi; Waleleng, Bradley Jimmy; Abimanyu, Abimanyu; Mulyadi, Yustar; Lucida, Maria Inge; Rezkhita, Yudith Annisa Ayu; Alfaray, Ricky Indra; Yamaoka, Yoshio

doi:10.1186/s13099-023-00551-2

Gut Pathogens

Table 5 Recommended lineage regimen used for H. pylori eradication

From: Management of dyspepsia and Helicobacter pylori infection: the 2022 Indonesian Consensus Report

Lineage	Regimen	Dosage	Duration	Caution	References
Antibiotic susceptibility test if available
First line Grade of recommendation: Strong	PPI triple Therapy (PAC)	• PPI^a bid • Amoxicillin 1000 mg bid • Clarithromycin 500 mg bid	14 days	Should be administered with caution in some regions of Indonesia with high Clarithromycin resistance (≥ 15%)^d or personal history of macrolide exposure	[7, 81]
Alternative regimen therapy Grade of recommendation: Strong	Concomitant non-bismuth quadruple therapy (PAMC)	• PPI^a bid • Amoxicillin 1000 mg bid • Metronidazole^b 500 mg bid (or Nitroimidazole) • Clarithromycin 500 mg bid	14 days	• Can be used when bismuth is not available • Can be the first lineage in areas with high clarithromycin resistance (≥ 15%)¹, if an antibiotic susceptibility test is not available • Can be used for patients with true penicillin allergy	[1, 5,6,7,8,9, 81]
Alternative regimen therapy Grade of recommendation: Conditional	Bismuth quadruple Therapy (PBMT)	• PPI^a bid • Bismuth^c qid • Metronidazole^b 400 mg qid or 500 mg tid–qid (or Nitroimidazole) • Tetracycline 500 mg qid	14 days	• Can be first lineage in areas with high clarithromycin resistance (≥ 15%)^d, if antibiotic susceptibility test not available • Can be an alternative rescue if the first line is failure • Currently, bismuth is not available in Indonesia	[1, 5,6,7,8,9]
An antibiotic susceptibility test is strongly recommended
Alternative rescue Grade of recommendation: Strong	High-dose dual therapy	Rabeprazole 20 mg qid Amoxicillin 750 mg qid	14 days	• Can only be used as an alternative rescue when the first lineage fails and in areas with high resistance to levofloxacin (≥ 15%)^e • Should be used in areas with rapid metabolizer population	[5, 6, 8]
Alternative rescue Grade of recommendation: Conditional	Rifabutin-containing therapy (PAR)	PPI^a bid Amoxicillin 1000 mg bid Rifabutin 150 mg bid or 300 mg qd	10 days	• Can only be used as an alternative rescue as the third or fourth line of treatment	[5, 6, 8]

^aThe dose depends on the PPI used. The standard doses are dexlansoprazole, 30 mg; esomeprazole, 20 mg; lansoprazole, 30 mg; omeprazole, 20 mg; pantoprazole, 40 mg; and rabeprazole, 20 mg, although a double dose is sometimes used for dexlansoprazole, esomeprazole, omeprazole, and rabeprazole to increase the success of eradication
^bMetronidazole may be substituted by tinidazole
^cThe dose depends on the formulation used. Examples include bismuth subsalicylate (262 mg), two tablets, colloidal bismuth subcitrate (120 mg), one tablet
^dAn area with high resistance to clarithromycin (≥ 15%) is Bali
^eAreas with high resistance to levofloxacin (≥ 15%) are Bali, Java, Kalimantan, Papua, Sulawesi, Sumatra, and Timor

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ISSN: 1757-4749

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