American Board of Internal Medicine (ABIM) Certification Practice Exam

Quadruple therapy for H. pylori infection is particularly indicated in what situation?

1. When the patient has no previous treatments

2. In areas with high degrees of drug resistance to clarithromycin

3. For patients with a history of peptic ulcers

4. When treating viral infections

The correct answer is: In areas with high degrees of drug resistance to clarithromycin

Quadruple therapy for H. pylori infection is particularly indicated in areas with high degrees of drug resistance to clarithromycin. This is important because the efficacy of antibiotic treatment for H. pylori can be compromised by resistance. In regions where a significant proportion of H. pylori strains are resistant to clarithromycin, using a more comprehensive treatment regimen that includes multiple antibiotics and a proton pump inhibitor can enhance eradication rates. Quadruple therapy typically consists of a proton pump inhibitor, bismuth, and two antibiotics (one of which is usually not clarithromycin) to cover resistant strains and ensure effective treatment. In contrast, other situations such as having no previous treatments or a history of peptic ulcers may not specifically necessitate quadruple therapy if susceptibility testing or previous treatment outcomes indicate that other regimens could be effective. Additionally, quadruple therapy is not suitable for treating viral infections, which have a completely different treatment approach. Therefore, the specific need for quadruple therapy aligns with addressing antibiotic resistance, which is a critical factor in the successful management of H. pylori infections.