American Board of Internal Medicine (ABIM) Certification Practice Exam

What type of antibiotic should be included in second-line salvage therapy for Helicobacter pylori infection?

1. A macrolide

2. An alternative to clarithromycin

3. A cephalosporin

4. A tetracycline

The correct answer is: An alternative to clarithromycin

In the context of treating Helicobacter pylori infection, second-line salvage therapy is generally aimed at addressing resistance or treatment failure in the first-line regimens. Given that clarithromycin has been a standard part of H. pylori treatment regimens, an alternative to clarithromycin is essential in salvage therapy. This is particularly important in regions with high clarithromycin resistance rates. An alternative to clarithromycin might involve using a different class of antibiotics that can effectively target H. pylori. Options like levofloxacin or metronidazole, for example, can be considered as alternatives in cases where clarithromycin is not an effective choice due to prior treatment failure or resistance. In contrast, while macrolides could be considered as options in some nonspecific contexts, they do not directly fit the requirement for salvage therapy that avoids clarithromycin. Cephalosporins are typically not first-line treatments for H. pylori and do not have established efficacy for this specific infection. Although tetracyclines can play a role in some regimens, they are best used in combination with other agents rather than as a stand-alone option that directly substitutes for clarithromycin. Thus, including an alternative to clarithromycin ensures a robust response