From the Guidelines
The recommended first-line treatment for H. pylori infection is standard triple therapy, consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin, for 14 days, if low clarithromycin resistance is present 1. This approach is based on moderate-quality evidence and is recommended by recent guidelines. The suggested doses are:
- PPI standard dose twice a day
- Clarithromycin 500 mg twice a day
- Amoxicillin 1000 mg twice a day In areas with high clarithromycin resistance, a 10-day sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) or a 10-day levofloxacin-amoxicillin triple therapy can be considered as alternative options 1. Key considerations in choosing a treatment regimen include the prevalence of resistant strains in the community and the patient's previous antibiotic exposure. It is essential to confirm treatment success with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing therapy and after PPI discontinuation for at least 2 weeks. H. pylori eradication is crucial because the bacterium causes chronic gastritis and is associated with peptic ulcer disease, gastric cancer, and MALT lymphoma. Increasing antibiotic resistance has reduced the effectiveness of traditional triple therapy regimens, making it essential to choose the most effective treatment approach based on local resistance patterns 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 to eradicate H. pylori in patients with H. pylori infection and duodenal ulcer disease.
- Dual therapy: amoxicillin and lansoprazole for patients who are allergic or intolerant to clarithromycin or have known or suspected resistance to clarithromycin 2
From the Research
H. pylori Treatment Overview
- H. pylori infection is a prevalent infection globally, presenting diagnostic and therapeutic challenges for clinicians worldwide 3.
- The "test-and-treat" strategy is the recommended approach for healthcare practitioners when managing this potentially curable disease 3.
Treatment Options
- The choice of testing method should be based on several factors including patient age, presenting symptoms, and medication use, as well as test reliability, availability, and cost 3.
- With rising antibiotic resistance, particularly of macrolides, care must be taken to ensure that therapy is selected based on regional resistance patterns and prior antibiotic exposure 3.
- Bismuth quadruple therapy, levofloxacin-based, or alternative macrolide-containing therapies are options for treatment 3.
- A study found that triple therapy with omeprazole, clarithromycin, and amoxicillin is an effective and well-tolerated treatment for eradication of H. pylori infection 4.
Common Mistakes in Treatment
- Common mistakes in the eradication of H. pylori include using standard triple therapy where it is ineffective, prescribing eradication therapy for only 7 to 10 days, and using a low dose of proton pump inhibitors 5.
- Failing to consider the importance of compliance with treatment and not checking the eradication success are also common mistakes 5.