What are the doses for amoxicillin (Amoxicillin) triple therapy for Helicobacter pylori (H. pylori) infection?

From the Guidelines

Amoxicillin triple therapy for H. pylori eradication should consist of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin taken twice daily for 14 days, with a standard dosing regimen of: a PPI (such as omeprazole 20 mg, lansoprazole 30 mg, esomeprazole 40 mg, or pantoprazole 40 mg) twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily 1. The 14-day duration is preferred over shorter courses as it provides higher eradication rates. For patients with penicillin allergy, metronidazole 500 mg twice daily can replace amoxicillin. The PPI component reduces gastric acid production, creating a less acidic environment that enhances antibiotic effectiveness. Amoxicillin disrupts bacterial cell wall synthesis, while clarithromycin inhibits bacterial protein synthesis. Some key points to consider:

• Treatment success should be confirmed with a urea breath test, stool antigen test, or endoscopy with biopsy at least 4 weeks after therapy completion and after PPI discontinuation for at least 2 weeks.
• Patients should be advised to take the full course of antibiotics even if symptoms improve before completion to ensure complete eradication and prevent antibiotic resistance.
• Inadequate acid suppression may undermine eradication efforts, and optimal dosing of PPIs is crucial 1.
• Amoxicillin should be used at a daily dose of at least 2g divided TID or QID to avoid low trough levels 1.
• The use of high-dose and more potent PPIs, PPIs not metabolized by CYP2C19 or potassium-competitive acid blockers if available, should be considered in cases of refractory H. pylori infection 1.

From the FDA Drug Label

1. 4 Dosage for H. pyloriInfection in Adults Triple therapy:The recommended adult oral dose is 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (every 12 hours) for 14 days. Dual therapy:The recommended adult oral dose is 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily (every 8 hours) for 14 days.

The doses for amoxicillin triple therapy for H pylori are:

• 1 gram of amoxicillin
• 500 mg of clarithromycin
• 30 mg of lansoprazole, all given twice daily for 14 days 2.

From the Research

Amoxicillin Triple Therapy for H pylori

• The doses for amoxicillin triple therapy for H pylori are as follows:
  • Amoxicillin: 1 g twice daily 3, 4, 5
  • Clarithromycin: 250 mg twice daily 6, 3 or 500 mg twice daily 4 or long-acting clarithromycin MR 1 g once daily 5
  • Omeprazole: 20 mg twice daily 6, 3 or esomeprazole 20 mg twice daily 4 or lansoprazole 60 mg twice daily 5
• The duration of the therapy can be 7 days 3, 4, 5 or 14 days 5
• The eradication rates of H pylori for patients under triple therapy can be up to 100% 5
• Factors known to influence response to H pylori eradication therapy include bacterial resistance and patient compliance 3