From the Guidelines
Triple therapy for H. pylori should consist of a proton pump inhibitor (PPI) plus two antibiotics for 14 days, with a standard regimen including omeprazole 20mg twice daily, amoxicillin 1g twice daily, and clarithromycin 500mg twice daily, as recommended by recent guidelines 1.
Treatment Regimens
The following treatment 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 with four drugs: PPI standard dose twice a day, amoxicillin 1000 mg twice a day, clarithromycin 500 mg twice a day, and metronidazole 500 mg twice a day, for 10 days 1.
- Levofloxacin triple therapy: PPI standard dose twice a day, levofloxacin 500 mg once a day or 250 mg twice a day, and amoxicillin 1000 mg twice a day, for 10 days 1.
Treatment Duration
Treatment duration should be 14 days in areas with high clarithromycin resistance, while 10 days may be sufficient in regions with lower resistance 1.
Patient Instructions
Patients should take medications as directed even if symptoms improve, avoid alcohol during treatment (especially with metronidazole), and be aware of potential side effects including diarrhea, nausea, and metallic taste 1.
Confirmation of Eradication
Confirmation of eradication with urea breath test, stool antigen test, or endoscopy should be performed at least 4 weeks after completing therapy 1.
Recent Guidelines
Recent guidelines recommend that standard triple therapy should be used as first-line therapy if low clarithromycin resistance is present, with a treatment duration of 14 days 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.
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 recommended triple therapy treatment dosing for H. pylori is:
- Amoxicillin: 1 gram, twice daily (every 12 hours) for 14 days
- Clarithromycin: 500 mg, twice daily (every 12 hours) for 14 days
- Lansoprazole: 30 mg, twice daily (every 12 hours) for 14 days 2, 2, 2.
From the Research
Triple Therapy Treatment Dosing for H. pylori
- The optimal dosing for triple therapy treatment of H. pylori infection is still being researched, but several studies have provided insights into effective treatment regimens 3, 4, 5.
- A study published in the United European gastroenterology journal found that 14-day therapies with clarithromycin-amoxicillin-bismuth and metronidazole-tetracycline-bismuth, both with high-dose proton pump inhibitors (PPIs), achieved optimal eradication rates 3.
- Another study published in Helicobacter found that a 14-day regimen of high-dose PPI, amoxicillin, and long-acting clarithromycin achieved a 100% eradication rate, regardless of CYP2C19 genotype 4.
- A review article published in Digestive diseases and sciences recommended considering bismuth quadruple therapy or levofloxacin-based therapy as first-line treatments, especially in areas with high macrolide resistance rates 6.
Treatment Regimens and Efficacy
- Triple therapy regimens have been shown to be more effective than dual therapy regimens in eradicating H. pylori and preventing ulcer recurrence 7, 5.
- A study published in The American journal of gastroenterology found that a 14-day course of lansoprazole-based triple therapy achieved a 94% eradication rate, compared to 77% or lower for dual therapy regimens 5.
- The use of high-dose PPIs and long-acting clarithromycin may improve eradication rates, especially in patients with rapid metabolizer genotypes 4.
Dosage and Duration
- The optimal dosage and duration of triple therapy treatment for H. pylori infection are still being researched, but studies suggest that 14-day regimens may be more effective than 7-day or 10-day regimens 3, 4, 5.
- High-dose PPIs may be beneficial in achieving optimal eradication rates, especially in 14-day triple therapy regimens 3, 4.