From the Guidelines
For the treatment of H. pylori infection, I recommend a combination therapy consisting of:
- Concomitant non-bismuth quadruple therapy:
- Proton pump inhibitor (PPI) twice daily, such as omeprazole 20mg or esomeprazole 20mg 1
- Amoxicillin 1000mg twice daily
- Metronidazole 500mg twice daily
- Clarithromycin 500mg twice daily
- Bismuth quadruple therapy:
- PPI twice daily, such as omeprazole 20mg or esomeprazole 20mg 1
- Bismuth subsalicylate 525mg four times daily
- Metronidazole 250mg four times daily
- Tetracycline 500mg four times daily for a duration of 14 days 1. It's essential to note that treatment should be individualized based on patient-specific factors, such as antibiotic allergy history and resistance patterns 1. In cases of refractory H. pylori infection, higher doses of metronidazole (1.5-2g daily) and high-dose PPIs may be considered 1. Additionally, penicillin allergy testing should be considered in patients labeled as having a penicillin allergy to potentially enable the use of amoxicillin 1.
From the FDA Drug Label
- 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 recommended medications and dosages for H. pylori infection are:
- Triple therapy:
- Amoxicillin: 1 gram, twice daily
- Clarithromycin: 500 mg, twice daily
- Lansoprazole: 30 mg, twice daily
- Dual therapy:
- Amoxicillin: 1 gram, three times daily
- Lansoprazole: 30 mg, three times daily Both therapies are given for 14 days 2
From the Research
Recommended Medications for H. pylori Infection
The following medications and dosages are recommended for the treatment of H. pylori infection:
- Dual therapy with omeprazole (120 mg daily, divided into 3 doses of 40 mg) and amoxicillin (3 x 750 mg daily for 14 days) has been shown to achieve an H. pylori eradication rate of over 90% 3
- Concomitant nonbismuth quadruple therapy (proton pump inhibitor + amoxicillin + metronidazole + clarithromycin) and traditional bismuth quadruple therapy (proton pump inhibitor + bismuth + metronidazole + tetracycline) are recommended as first-line strategies for 14 days 4
- PPI triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole) is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens 4
- Rescue therapies include bismuth quadruple therapy and levofloxacin-containing therapy (PPI + amoxicillin + levofloxacin) 4
- Rifabutin regimens should be restricted to patients who have failed to respond to at least 3 prior options 4
- Nitrofurantoin quadruple therapy has been shown to be effective in eradicating H. pylori, but its efficacy is reduced in the presence of metronidazole resistance 5
- Amoxicillin-clavulanate combination has been shown to have a higher activity than amoxicillin alone against H. pylori, and beta-lactamase inhibitors have been shown to have 'in-vitro' antibacterial activity against H. pylori 6
- High-dose dual therapy (proton-pump-inhibitor plus amoxicillin) and vonoprazan, a more potent acid inhibitor, are promising alternatives that could decrease misuse of antibiotics 7
Dosage and Treatment Duration
The recommended treatment duration for H. pylori infection is 14 days 4 The following dosages are recommended:
- Omeprazole: 120 mg daily, divided into 3 doses of 40 mg 3
- Amoxicillin: 3 x 750 mg daily for 14 days 3
- Clarithromycin: 500 mg twice daily for 14 days 4
- Metronidazole: dose not specified 4
- Tetracycline: dose not specified 4
- Levofloxacin: dose not specified 4
- Rifabutin: dose not specified 4
- Nitrofurantoin: 100 mg three times daily for 14 days 5
- Amoxicillin-clavulanate: 875 mg plus 125 mg clavulanic acid twice daily for 7 days 6