A Malaysian consensus report on the diagnosis and treatment of Helicobacter pylori infection

Abstract

Helicobacter pylori is one of the most common chronic bacterial infections in humans and responsible for 90% of duodenal ulcers and 70-90% of gastric ulcers. Despite this, many misconceptions regarding the appropriate diagnostic method and treatment strategies still exist in the Malaysian clinical practice. Under the initiative of the steering committee, an expert panel consisting of nine key opinion leaders in the field of gastroenterology convened to develop a set of consensus statements that are relevant to the Malaysian healthcare practice. The panel members reviewed the current evidence on the management of H. pylori infection, focusing on the best practices that are relevant to the Malaysian population based on clinical experience and published clinical evidence. Using the modified Delphi method, the panel achieved consensus in three areas of H. pylori infection management: indications for testing, diagnosis, and treatment. The panel proposed a set of 19 consensus statements, which were synthesized via two rounds of blinded voting and group discussions. The recommendations provided are relevant to the Malaysian population and can be used as a guide by physicians across various healthcare settings to facilitate appropriate diagnostic testing and treatment of H. pylori infection.

Genetic variations of penicillin-binding protein 1A: insights into the current status of amoxicillin-based regimens for Helicobacter pylori eradication in Malaysia

“…As such, in each country, their local antimicrobial resistance patterns are important in influencing the formulation of first-line treatments for H. pylori infection. Hence, knowing the resistance profile of H. pylori , especially to amoxicillin, the first-line treatment antibiotic will guide the choice of antibiotic combinations, enhancing the success rate of H. pylori eradication [32].…”

“…Based on the Maastricht V/ Florence Consensus Report, amoxicillin is always paired with either clarithromycin, metronidazole or levofloxacin in the standard first-line therapy [4]. In Malaysia, the combination of clarithromycin, amoxicillin and rabeprazole (proton pump inhibitor) is recommended for H. pylori eradication [5]. However, the efficacy of clarithromycin has declined due to the rising antibiotic resistance in H. pylori [1].…”

“…In Malaysia, amoxicillin remains a key component in several H. pylori treatment therapies including standard triple therapy (STT: 20 mg rabeprazole, 1000 mg amoxicillin and 500 mg clarithromycin) and high-dose dual therapy (HDDT: 20 mg rabeprazole and 1000 mg amoxicillin) [31,32]. Both 14-day STT and HDDT treatments achieved a high eradication rate that was based on intention-to-treat and per-protocol analysis.…”

Real‐world practice of Helicobacter pylori management: A survey among physicians in Southeast Asia

“…In the recent consensus on H. pylori management in Malaysia, another inter-CLA country in the region, this regimen is still recommended as an option for first-line treatment, but the 14-day duration is emphasized as an essential point. 19 However, inter-CLA countries should have rigorous monitoring programs for clarithromycin resistance. Regarding secondline therapy, the most common regimen was PBMT (59.8%) if regimens other than PBMT had been used, while the availability of bismuth in the inter-CLA countries was 72.3%.…”

“…11,16 However, in this study, we address the inter-CLA group separately because recent real-world studies across countries in this group have shown that the eradication rate of the 14-day triple clarithromycin-based regimen remained over 90% given that the treatment duration was 14 days, and it is still recommended as a firstline regimen in recent updated national guidelines. [17][18][19] All statistical analyses were performed with SPSS 23 (SPSS Inc.).…”