What is the treatment for Helicobacter pylori (H. pylori) infection?

From the Guidelines

H. pylori infection should be treated with a standard triple therapy regimen consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 14 days, as this approach has been shown to be effective in eradicating the infection and reducing the risk of recurrent bleeding and other complications 1.

Treatment Options

The treatment of H. pylori infection typically involves a combination of medications, including:

• A proton pump inhibitor (PPI) such as omeprazole 20mg twice daily
• Amoxicillin 1g twice daily
• Clarithromycin 500mg twice daily For patients allergic to penicillin, metronidazole 500mg twice daily can replace amoxicillin.

Alternative Therapies

If triple therapy fails, alternative therapies such as quadruple therapy or sequential therapy may be considered 1.

Importance of Eradication

H. pylori eradication is important because the bacterium causes chronic gastritis and is associated with peptic ulcers, gastric cancer, and MALT lymphoma 1.

Key Considerations

When treating H. pylori infection, it is essential to consider the following:

• The prevalence of antibiotic resistance in the local population
• The patient's medical history and potential allergies
• The need for careful monitoring and follow-up to ensure eradication of the infection By taking a proactive approach to testing and treatment, and by adopting the principles of antibiotic usage and antimicrobial stewardship, healthcare providers can help to reduce the risk of complications and improve patient outcomes 1.

From the FDA Drug Label

Adult Patients only Helicobacter pylori Infection and Duodenal Ulcer Disease: Triple therapy for Helicobacter pylori (H. pylori) with clarithromycin and lansoprazole : Amoxicillin, in combination with clarithromycin plus lansoprazole as triple therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori. Dual therapy for H. pylori with lansoprazole : Amoxicillin, in combination with lansoprazole delayed-release capsules as dual therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) who are either allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected.

H. pylori treatment options with amoxicillin include:

• Triple therapy: amoxicillin, clarithromycin, and lansoprazole
• Dual therapy: amoxicillin and lansoprazole, for patients who are allergic or intolerant to clarithromycin, or in cases of known or suspected clarithromycin resistance 2

From the Research

H. pylori Treatment Options

• The treatment of H. pylori infection typically involves a combination of antibiotics and a proton pump inhibitor (PPI) 3, 4, 5, 6, 7.
• Studies have shown that PPI-based triple therapy, such as lansoprazole, amoxicillin, and clarithromycin, can be effective in eradicating H. pylori infection 3, 4, 6.
• However, the efficacy of this regimen can be affected by antibiotic resistance, particularly to clarithromycin 4, 5, 7.
• Alternative treatment options, such as bismuth quadruple therapy, have been shown to be effective in areas with high prevalence of antibiotic resistance 5, 7.
• The choice of PPI does not appear to significantly impact the eradication rate of H. pylori 4.

Treatment Regimens

• Lansoprazole, amoxicillin, and clarithromycin for 14 days has been shown to be effective in eradicating H. pylori infection 3, 4, 6.
• Bismuth quadruple therapy, consisting of lansoprazole, amoxicillin, bismuth, and metronidazole or clarithromycin, has been shown to be effective in areas with high prevalence of antibiotic resistance 7.
• The efficacy of these regimens can be affected by factors such as antibiotic resistance and patient compliance 4, 6, 7.

Antibiotic Resistance

• Antibiotic resistance, particularly to clarithromycin, can significantly impact the efficacy of H. pylori treatment regimens 4, 5, 7.
• The use of alternative antibiotics, such as amoxicillin and metronidazole, can help to overcome resistance 7.
• The prevalence of antibiotic resistance can vary by region and should be taken into account when selecting a treatment regimen 5, 7.