From the Guidelines
Antibiotics are not typically the first-line treatment for gastritis unless it's caused by Helicobacter pylori (H. pylori) infection, and the most effective treatment regimen is triple therapy consisting of a proton pump inhibitor (PPI) and two antibiotics, as recommended by the most recent study 1.
Treatment Regimens
The standard treatment for H. pylori-associated gastritis includes:
- Triple therapy: a PPI such as omeprazole 20mg twice daily, plus two antibiotics: clarithromycin 500mg twice daily and either amoxicillin 1000mg twice daily or metronidazole 500mg twice daily, as described in the study 1.
- Quadruple therapy: a PPI, bismuth subsalicylate, tetracycline, and metronidazole, as mentioned in the study 1.
Duration and Follow-up
The treatment regimen is usually prescribed for 10-14 days, and it's essential to complete the full course of antibiotics even if symptoms improve before finishing, as stated in the study 1. Treatment success should be confirmed with follow-up testing 4-8 weeks after completing therapy.
Non-H. pylori Gastritis
For non-H. pylori gastritis, treatment focuses on addressing the underlying cause (such as stopping NSAIDs) and reducing stomach acid with PPIs or H2 blockers rather than using antibiotics, as they would be ineffective and could contribute to antibiotic resistance, as discussed in the study 1.
Key Considerations
- The choice of therapy should consider effectiveness and cost of various regimens versus side effects, as mentioned in the study 1.
- Increasing antimicrobial resistance has resulted in an overall decline in treatment success, causing a rethinking of the approach to development of treatment guidelines, as stated in the study 1.
- The complexity of testing and treatment of H. pylori supports the superiority of PPI therapy alone in its simplicity and efficacy, even for H. pylori–infected patients, as demonstrated in the study 1.
From the FDA Drug Label
In the triple therapy clinical trials, 84. 9% (157/185) of the patients in the omeprazole/clarithromycin/amoxicillin treatment group who had pretreatment amoxicillin susceptible MICs (≤ 0.25 mcg/mL) were eradicated of H. pylori and 15. 1% (28/185) failed therapy. Omeprazole and clarithromycin dual therapy and omeprazole, clarithromycin and amoxicillin triple therapy have been shown to be active against most strains of Helicobacter pylori in vitro and in clinical infections 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.
The best antibiotics for gastritis caused by H. pylori are:
- Amoxicillin
- Clarithromycin These antibiotics are often used in combination with a proton pump inhibitor such as omeprazole or lansoprazole to eradicate H. pylori and reduce the risk of duodenal ulcer recurrence 2 3.
From the Research
Best Antibiotics for Gastritis
The best antibiotics for gastritis, particularly for Helicobacter pylori (H. pylori) infection, are typically part of a combination therapy. The choice of antibiotics depends on various factors including the patient's previous antibiotic exposure and the prevalence of antibiotic resistance in the region.
First-Line Treatment Options
- Clarithromycin triple therapy is recommended for patients with no previous history of macrolide exposure and in areas where clarithromycin resistance is low 4.
- Bismuth quadruple therapy or concomitant therapy consisting of a proton pump inhibitor (PPI), clarithromycin, amoxicillin, and metronidazole are also effective first-line treatments 4.
- A regimen composed of omeprazole, metronidazole, and amoxicillin has been shown to be more effective than a regimen composed of lansoprazole, clarithromycin, and amoxicillin 5.
Quadruple Therapy
- A quadruple therapy regimen consisting of omeprazole, metronidazole, clarithromycin, and amoxicillin has been shown to be effective and safe for H. pylori eradication 6.
- This regimen has an eradication rate of over 90% and can be completed in just 5 days 6.
Considerations
- The prevalence of antibiotic resistance, particularly clarithromycin resistance, is increasing and should be taken into account when choosing a treatment regimen 7, 4, 8.
- Patients should be asked about their previous antibiotic exposure to guide the choice of treatment 4.
- The choice of first-line therapy should be based on what works best in a defined geographical area and should take into account the prevalence of antimicrobial resistance in that region 8.