What are the most effective antibiotics for treating gastritis?

From the Guidelines

For H. pylori-associated gastritis, the most effective treatment is a 14-day course of triple therapy consisting of a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, plus two antibiotics: amoxicillin 1000mg twice daily and either clarithromycin 500mg twice daily or metronidazole 500mg twice daily, as recommended by the most recent guidelines 1.

Treatment Options

• Triple therapy: PPI + amoxicillin + clarithromycin or metronidazole
• Quadruple therapy: PPI + bismuth subsalicylate + tetracycline + metronidazole

Key Considerations

• The choice of treatment should consider effectiveness, cost, and potential side effects
• Treatment should achieve an eradication rate of over 80% on a rigorous intention to treat basis
• Eradication of H. pylori is associated with a decrease in the recurrence rate among patients with early gastric cancer

Recent Guidelines

• The 2021 AGA clinical practice update recommends triple therapy as the first-line treatment for H. pylori-associated gastritis 1
• The 2022 Annual Review of Medicine suggests a proactive approach to testing and treatment of H. pylori, including outreach to family members of individuals diagnosed with active infection and high-risk local populations 1

Important Notes

• Antibiotics are not typically the first-line treatment for gastritis unless it's caused by H. pylori infection
• For non-H. pylori gastritis, treatment focuses on acid suppression with PPIs or H2 blockers, avoiding irritants like alcohol and NSAIDs, and addressing the underlying cause rather than using antibiotics
• It's essential to complete the full course of antibiotics even if symptoms improve before finishing, as recommended by the 2012 Maastricht IV/Florence Consensus Report 1

From the FDA Drug Label

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. 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

The best antibiotics for gastritis caused by Helicobacter pylori are:

• Amoxicillin in combination with clarithromycin and a proton pump inhibitor (such as omeprazole or lansoprazole) as triple therapy
• Clarithromycin and omeprazole dual therapy may also be effective, but triple therapy is generally more effective 2, 3 Key points:
• The choice of antibiotic therapy should be based on susceptibility testing and local epidemiology
• Treatment should be used only to treat infections that are proven or strongly suspected to be caused by bacteria
• The goal of treatment is to eradicate H. pylori and reduce the risk of duodenal ulcer recurrence

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.