Test for cure with a urea breath test or stool antigen test at least four weeks after finishing antibiotics. Stop proton pump inhibitors or potassium-competitive acid blockers two weeks before testing; both suppress the organism and cause false negatives. Serology stays positive after cure and cannot be used.
If eradication fails, do not repeat clarithromycin. Choose a regimen based on susceptibility testing or switch to bismuth quadruple therapy.
- Breath or stool antigen test ≥4 weeks after antibiotics.
- Stop acid suppression 2 weeks before testing.
- Never use serology to confirm cure.
- Do not reuse clarithromycin after failure.
Why it matters
False-negative tests on acid suppression hide treatment failure.
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