From the Guidelines
The treatment for a positive Urea Breath Test indicating H. pylori infection is a combination therapy known as triple therapy, consisting of a proton pump inhibitor (PPI) such as omeprazole 20mg or esomeprazole 40mg twice daily, plus two antibiotics—usually amoxicillin 1g twice daily and clarithromycin 500mg twice daily—for 10-14 days, as recommended by the most recent and highest quality study 1.
Key Considerations
- The choice of therapy should consider effectiveness and cost of various regimens versus side effects, with PPIs having in vitro activity against H. pylori 1.
- For patients allergic to penicillin, metronidazole 500mg twice daily can replace amoxicillin 1.
- In areas with high clarithromycin resistance or after failed first-line therapy, alternative therapies may be considered, but the first-line treatment remains the most effective and simplest approach 1.
Treatment Adherence and Follow-up
- Treatment adherence is crucial for eradication success, so patients should complete the full course even if symptoms improve 1.
- After treatment, confirmation of eradication is typically done with another UBT, but only after 4-6 weeks and discontinuation of PPIs for 2 weeks before testing to avoid false negatives.
Importance of H. pylori Eradication
- H. pylori eradication is important because the bacterium causes chronic gastritis and increases risk for peptic ulcers and gastric cancer, with successful treatment significantly reducing these risks 1.
From the FDA Drug Label
1.2 Helicobacter pylori Eradication to Reduce the Risk of Duodenal Ulcer Recurrence Eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence. Triple Therapy Omeprazole delayed-release capsules in combination with clarithromycin and amoxicillin, is indicated for treatment of patients with H pylori infection and duodenal ulcer disease (active or up to 1-year history) to eradicate H. pylori in adults.
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 treatment for a positive Urea Breath Test (UBT) result indicating Helicobacter pylori (H. pylori) infection is:
- Triple Therapy:
From the Research
Urea Breath Test Positive Result
A positive Urea Breath Test (UBT) result indicates the presence of Helicobacter pylori (H. pylori) infection. The treatment for H. pylori infection typically involves a combination of antibiotics and acid suppressors.
Treatment Options
- The standard treatment for H. pylori infection is a triple therapy regimen, which includes two antibiotics and an acid suppressor 4.
- A quadruple therapy regimen, which adds a fourth medication to the standard triple therapy, has also been shown to be effective in eradicating H. pylori infection 4.
- The choice of treatment regimen depends on various factors, including the patient's medical history, the presence of any underlying conditions, and the severity of the infection.
Diagnostic Tests
- The UBT is a highly sensitive and specific test for diagnosing H. pylori infection 5, 6, 7, 8.
- The test involves the oral administration of a solution containing urea labelled with the non-radioactive natural carbon 13.
- The UBT can be used to diagnose the presence or absence of H. pylori infection, as well as to monitor the effectiveness of treatment.
Considerations
- The UBT should be performed 4 to 6 weeks after the end of treatment to avoid false negative results 5.
- The test should also be performed 5 days after the end of acid suppressive drugs to ensure accurate results 5.
- The UBT is a non-invasive and safe test, making it an ideal diagnostic tool for H. pylori infection 6, 7, 8.