What is the recommended treatment for H pylori (Helicobacter pylori) infection?

From the Guidelines

The recommended treatment for H. pylori infection is a 14-day bismuth quadruple therapy, which is the most effective approach to succeed on the first attempt and reduce the risk of antibiotic resistance. This approach is supported by recent guidelines, including the 2019 reconciliation of H. pylori treatment guidelines in a time of increasing resistance to antibiotics 1. The bismuth quadruple therapy consists of a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, along with three antibiotics: amoxicillin 1g twice daily, clarithromycin 500mg twice daily, and metronidazole 500mg twice daily, or bismuth subsalicylate (525mg four times daily) as an alternative.

Some key points to consider when treating H. pylori infection include:

• The importance of avoiding antibiotic overuse and promoting antibiotic stewardship 1
• The need to consider local resistance patterns and previous antibiotic exposure when selecting a treatment regimen 1
• The recommendation to use bismuth quadruple therapy as first-line treatment in areas with high clarithromycin resistance or after failed initial treatment 1
• The importance of confirming treatment success with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing therapy and after stopping PPI medications for at least 2 weeks 1

It's worth noting that the most recent and highest quality study, published in 2022, emphasizes the importance of adopting 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. However, the specific treatment recommendations in this study are consistent with the 2019 guidelines, which emphasize the importance of bismuth quadruple therapy as a first-line treatment option.

From the FDA Drug Label

Adult Patients only Helicobacter pylori Infection and Duodenal Ulcer Disease: Triple therapy for Helicobacter pylori (H. pylori) with clarithromycin and lansoprazole : 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.

1. 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. Dual therapy: The recommended adult oral dose is 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily (every 8 hours) for 14 days.

The recommended treatment for H pylori infection is triple therapy with 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily for 14 days, or dual therapy with 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily for 14 days 2.

• Triple therapy is used to treat patients with H pylori infection and duodenal ulcer disease.
• Dual therapy is used for patients who are allergic or intolerant to clarithromycin, or in cases where resistance to clarithromycin is known or suspected. Key points to consider:
• The treatment should be taken for 14 days.
• The dosage regimen may vary depending on the severity of the infection and the patient's renal function. It is essential to follow the recommended dosage and administration instructions to ensure effective treatment and minimize the risk of adverse reactions 2.

From the Research

H pylori Treatment Overview

• The recommended treatment for H pylori infection typically involves a combination of medications, including antibiotics and a proton pump inhibitor (PPI) 3, 4, 5.
• The goal of treatment is to eradicate the bacteria and prevent complications, such as gastric ulcers and cancer.

First-Line Treatment Options

• Clarithromycin triple therapy, which includes clarithromycin, a PPI, and amoxicillin or metronidazole, is a common first-line treatment option 4, 5.
• Bismuth quadruple therapy, which includes bismuth salt, a PPI, tetracycline, and metronidazole or amoxicillin, is another first-line option 4, 5.
• Concomitant therapy, which includes clarithromycin, a PPI, amoxicillin, and metronidazole, is also a first-line option 4.

Second-Line Treatment Options

• Bismuth-based quadruple therapies and levofloxacin-based regimens have been shown to be effective second-line options 5.
• Sequential therapy, which involves taking antibiotics in a specific sequence, has also been shown to be effective 3, 6.

Treatment Considerations

• Antibiotic resistance is a significant concern in H pylori treatment, and treatment regimens should be selected based on resistance patterns 3, 4, 5, 6.
• Patient factors, such as penicillin allergies and pregnancy, should also be considered when selecting a treatment regimen 4.
• Treatment duration and compliance are also important factors in achieving successful eradication of H pylori 3, 5, 6.