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

From the Guidelines

The standard treatment for Helicobacter pylori infection typically involves a triple therapy regimen consisting of a proton pump inhibitor (PPI) plus two antibiotics for 10-14 days, with the most common first-line regimen including omeprazole 20 mg twice daily, amoxicillin 1 gram twice daily, and clarithromycin 500 mg twice daily 1.

Treatment Regimens

The following regimens are recommended:

• Standard triple therapy: PPI standard dose twice a day, clarithromycin 500 mg twice a day, and amoxicillin 1000 mg twice a day, or metronidazole 500 mg twice a day 1.
• Sequential therapy: PPI standard dose twice a day, amoxicillin 1000 mg twice a day for the first 5 days, followed by PPI plus clarithromycin 500 mg twice a day and metronidazole 500 mg twice a day for the next 5 days 1.
• Levofloxacin-based therapy: PPI standard dose twice a day, amoxicillin 1000 mg twice a day, and levofloxacin 500 mg once daily for 10-14 days 1.

Dosing Considerations

• PPI standard dose is twice a day, with the specific dose depending on the PPI used, such as omeprazole 20 mg, lansoprazole 30 mg, or pantoprazole 40 mg 1.
• Amoxicillin dose is 1000 mg twice a day, and clarithromycin dose is 500 mg twice a day 1.
• Metronidazole dose is 500 mg twice a day, and levofloxacin dose is 500 mg once daily or 250 mg twice a day 1.

Treatment Duration

• The recommended treatment duration is 10-14 days, with 14 days being the preferred length of first-line therapy 1.

From the FDA Drug Label

2.4 Dosage for H. pylori Infection 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 dose of amoxicillin for H. pylori treatment in adults is:

• 1 gram every 12 hours for 14 days as part of a triple therapy regimen 2
• 1 gram every 8 hours for 14 days as part of a dual therapy regimen 2

From the Research

H pylori Treatment Dose

• The optimal dose of proton pump inhibitors (PPIs) for H pylori eradication treatment is still being researched, with studies suggesting that high-dose PPIs may be more effective in certain treatment regimens 3, 4.
• A study published in 2024 found that optimal first-line effectiveness was achieved with 14-day therapies using clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both independently of the PPI dose prescribed, as well as with 10-day and 14-day therapies using high-dose PPIs 3.
• Another study published in 2013 found that a 14-day regimen using a high-dose PPI, amoxicillin, and clarithromycin achieved a 100% eradication rate, regardless of the CYP2C19 genotype 4.
• The choice of PPI may not be important in the eradication rate of H pylori, with similar eradication rates achieved with lansoprazole and pantoprazole 5.
• Quadruple therapy regimens, which add a fourth medication to the standard triple therapy, have also been shown to be effective in eradicating H pylori, with one study finding a 96% eradication rate using a 5-day quadruple regimen 6.

Treatment Regimens

• First-line treatment regimens for H pylori eradication may include:
  • 14-day therapies using clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth 3
  • 10-day and 14-day therapies using high-dose PPIs 3
  • Quadruple therapy regimens, such as amoxicillin/metronidazole/omeprazole/clarithromycin 6
• Second-line treatment regimens may include:
  • Metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10-days with standard and high-dose PPIs, respectively 3
  • Levofloxacin-amoxicillin triple therapy for 14-days with high-dose PPIs 3

Duration of Treatment

• The duration of treatment for H pylori eradication may vary, with studies suggesting that 10- to 14-day treatment regimens may be more effective than 7-day regimens 3, 4.
• One study found that a 14-day regimen was more effective than a 7-day regimen in achieving eradication, particularly in patients with rapid metabolizer genotypes 4.