What is the recommended treatment for Helicobacter pylori infection?

From the Guidelines

The recommended treatment for Helicobacter pylori infection is a 14-day bismuth quadruple therapy, which includes a proton pump inhibitor (PPI), two antibiotics, and bismuth subsalicylate, as it has been shown to have a higher success rate and is less affected by antibiotic resistance 1. This approach is supported by recent guidelines that prioritize the use of bismuth quadruple therapy, especially in areas with high dual resistance to clarithromycin and metronidazole 1. The use of a PPI, such as omeprazole 20mg twice daily, combined with two antibiotics, usually amoxicillin 1g twice daily and clarithromycin 500mg twice daily, and bismuth subsalicylate (525mg four times daily) for 14 days, is a recommended first-line treatment. Some key points to consider when treating H. pylori infection include:

• The importance of using a combination therapy approach to effectively eradicate the infection
• The need to consider local antibiotic resistance patterns when selecting a treatment regimen
• The use of bismuth quadruple therapy as a first-line treatment in areas with high dual resistance to clarithromycin and metronidazole
• The recommendation to use a 14-day treatment duration to increase the chances of successful eradication 1 Alternative regimens, such as sequential therapy or levofloxacin-based therapy, may be considered in certain situations, but the bismuth quadruple therapy remains the preferred first-line treatment due to its high efficacy and low risk of resistance 1. Eradication should be confirmed with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing treatment and after stopping PPI therapy for at least 2 weeks.

From the FDA Drug Label

Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (every 12 hours) for 14 days. Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, all given three times daily (every 8 hours) for 14 days.

The recommended treatment for Helicobacter pylori infection is:

• Triple therapy: amoxicillin 1 gram, clarithromycin 500 mg, and lansoprazole 30 mg, all given twice daily for 14 days.
• Dual therapy: amoxicillin 1 gram and lansoprazole 30 mg, all given three times daily for 14 days 2 2.

From the Research

Recommended Treatment for Helicobacter pylori Infection

The recommended treatment for Helicobacter pylori infection varies depending on the region and the prevalence of antibiotic resistance.

• In regions with low clarithromycin resistance, several treatment regimens can achieve high eradication rates, including:
  • 14-day hybrid or reverse hybrid therapy
  • 10-14 day sequential therapy
  • 7-14 day concomitant therapy
  • 10-14 day bismuth quadruple therapy
  • 14-day triple therapy 3
• In areas with high clarithromycin resistance, standard triple therapy should be abandoned, and the following regimens are recommended:
  • 14-day hybrid or reverse hybrid therapy
  • 10-14 day concomitant therapy
  • 10-14 day bismuth quadruple therapy 3

First-Line Treatment Options

Several studies have evaluated the efficacy of different first-line treatment regimens for Helicobacter pylori infection.

• A study published in 2001 found that all different proton pump inhibitors (PPIs) are equivalent when prescribed with antibiotics, and that ranitidine bismuth citrate is equal to or more effective than PPI in some cases 4
• A study published in 2007 found that triple therapy consisting of two antibiotics and a PPI is the first-line option for Helicobacter pylori infection, but that bismuth-based quadruple therapy is also a first-line regimen in areas with high rates of clarithromycin and metronidazole resistance 5
• A study published in 2009 found that the recommended first-line treatment in Europe and North America is a PPI combined with amoxicillin and clarithromycin, but that rates of eradication with this regimen are falling due to antibiotic resistance and poor compliance with therapy 6

Alternative Treatment Regimens

Several alternative treatment regimens have been evaluated for Helicobacter pylori infection.

• A study published in 2015 found that a 14-day modified bismuth quadruple therapy regimen containing lansoprazole, amoxicillin, bismuth potassium citrate, and metronidazole or clarithromycin achieved high cure rates and was well-tolerated 7
• Other studies have found that levofloxacin-based regimens and rifabutin-based regimens are effective second-line options for Helicobacter pylori infection 5, 6