From the Guidelines
Triple therapy for H. pylori should include a proton pump inhibitor (PPI) plus two antibiotics, with the most common regimen being a PPI, clarithromycin, and amoxicillin, for 10-14 days, as recommended by recent guidelines 1. The choice of antibiotics may vary depending on patient factors, such as penicillin allergy, and local resistance patterns. Some options for triple therapy include:
- Clarithromycin triple: clarithromycin 500mg bid, amoxicillin 1g bid or metronidazole 500 mg bid, PPI bid x 14 days
- Levofloxacin triple: levofloxacin 500mg qd, amoxicillin 1g bid, PPI bid x 14 days
- Rifabutin triple: rifabutin 150 or 300 mg daily, amoxicillin 1g bid, PPI bid x 10 days It is essential to note that increasing antibiotic resistance, particularly to clarithromycin, has reduced the effectiveness of standard triple therapy in many regions, leading to consideration of quadruple therapy or bismuth-based regimens in areas with high resistance rates 1. Patients should take the PPI 30 minutes before meals for optimal acid suppression, and compliance is crucial for successful eradication. The treatment regimen should be chosen based on the most recent and highest-quality evidence, taking into account local resistance patterns and patient factors.
From the FDA Drug Label
Dosing for H. pylori Infection (in Adults): Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (every 12 hours) for 14 days. The options for triple therapy for H. pylori include:
- Amoxicillin: 1 gram, twice daily
- Clarithromycin: 500 mg, twice daily
- Lansoprazole: 30 mg, twice daily All three medications are given for 14 days 2.
From the Research
Triple Therapy Options for H. pylori
- The following triple therapy regimens have been studied for H. pylori eradication:
- These regimens typically include two antibiotics and a proton pump inhibitor to suppress acid production and enhance antibiotic effectiveness.
Efficacy of Triple Therapy Regimens
- A study comparing metronidazole, omeprazole, and clarithromycin with a quadruple therapy regimen found similar eradication rates for both treatments 3.
- Another study found that amoxicillin, metronidazole, and omeprazole was more effective than amoxicillin, clarithromycin, and lansoprazole as a first-line treatment 5.
- A systematic review and meta-analysis found that amoxicillin, metronidazole, and a proton pump inhibitor was less efficacious than clarithromycin-including triple therapies, but its efficacy was similar to that of amoxicillin, clarithromycin, and a proton pump inhibitor when drugs were administered for 14 days 6.