Published online Nov 28, 2021. doi: 10.3748/wjg.v27.i44.7661
Peer-review started: April 12, 2021
First decision: June 3, 2021
Revised: June 17, 2021
Accepted: November 10, 2021
Article in press: November 10, 2021
Published online: November 28, 2021
Therapy of Helicobacter pylori (H.pylori) requires a combination of antibiotics together with an acid suppressing agent; most treatment regimens include Amoxicillin as one of the antibiotics, which is an important constituent as resistance to it is low. However, allergies to the penicillin group of antibiotics are not uncommon, and treating H.pylori infection in such individuals can be challenging due to the restricted choice of regimens. The aim of this review is to summarise the evidence for therapeutic options in patients with H.pylori infection and penicillin allergy. A literature search was conducted in PubMed for English language publications using the key words ‘Helicobacter’ and ‘treatment’ or ‘therapy‘ and ‘penicillin’ or ‘beta-lactam’ and ‘allergy’ or ‘anaphylaxis’. Eighteen studies were identified that specifically evaluated H.pylori treatment success in penicillin allergic patients. The number of subjects in most of them was low and many were retrospective, uncontrolled, single cohort studies. The most effective option for first-line treatment appears to be Bismuth-based quadruple therapy for 10-14 d. The evidence supports second-line treatment with Levoflaxacin-based triple therapy for 10 d. Patients with persistent H.pylori infection after 2 treatment courses should be considered for testing to confirm penicillin allergy. Further treatment should be guided by the results of H.pylori culture and sensitivity testing.
Core Tip: Penicillin allergy is a not uncommon occurrence and treating Helicobacter pylori infection in such individuals can be challenging. This review highlights the lack of high-quality studies to help guide management strategies. Recommendations have been made based on the limited data, but it would be important to monitor the success of treatment regimens and use what can be demonstrated to be effective locally.