American Board of Internal Medicine (ABIM) Certification Practice Exam

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Prepare for the American Board of Internal Medicine Exam with our multiple choice questions and detailed explanations. Enhance your medical knowledge and skills to excel in your certification exam with confidence!

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What regimen is recommended for treating Helicobacter pylori infection in patients with macrolide antibiotic exposure?

Amoxicillin, levofloxacin, and omeprazole
Clarithromycin, amoxicillin, and metronidazole
Amoxicillin, clarithromycin, and omeprazole
Omeprazole and metronidazole

The correct answer is: Amoxicillin, levofloxacin, and omeprazole

The recommended regimen for treating Helicobacter pylori infection in patients with prior macrolide antibiotic exposure prioritizes the avoidance of any macrolide agents, such as clarithromycin, to which the bacteria may have developed resistance due to previous exposure. This resistance diminishes the efficacy of treatment regimens that include clarithromycin. Instead, the combination of amoxicillin, levofloxacin, and omeprazole provides an effective alternative. Amoxicillin acts as a potent antibiotic against H. pylori, levofloxacin, a fluoroquinolone antibiotic, has shown efficacy in treating infections caused by resistant bacteria, and omeprazole as a proton pump inhibitor helps in reducing gastric acidity, enhancing the effectiveness of the antibiotics. This regimen is designed to maximize the chance of eradication of the infection in patients who have potential resistance issues due to past macrolide use. Other combinations that include clarithromycin or a similar macrolide are less appropriate in these cases due to the risk of treatment failure associated with resistance. Hence, the formulation of amoxicillin, levofloxacin, and omeprazole stands out as a more effective strategy in these patients.