What is the guideline treatment for gastritis, especially when caused by Helicobacter pylori (H. pylori)?

From the Guidelines

The guideline treatment for gastritis caused by Helicobacter pylori involves a combination therapy approach known as triple therapy, with the first-line treatment typically 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 study 1. The treatment approach is based on the principles of antimicrobial stewardship, which aims to optimize current therapies to reliably achieve high cure rates 1. Some key points to consider in the treatment of H. pylori gastritis include:

• The use of susceptibility-based therapy, which takes into account the local susceptibility patterns of the bacteria 1
• The optimization of therapy to achieve high cure rates, including the use of optimized drug regimens, doses, and duration of therapy 1
• The importance of testing for H. pylori eradication after completing treatment, typically using a urea breath test or stool antigen test at least 4 weeks after therapy and while off PPI therapy for at least 2 weeks 1
• The consideration of alternative therapies, such as quadruple therapy, for patients who fail first-line therapy or have high clarithromycin resistance 1 The treatment of non-H. pylori gastritis focuses on removing the underlying cause, such as NSAIDs or alcohol, and using PPIs to reduce stomach acid and allow healing 1. It is essential to note that the choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, as the response to eradication therapy is significantly related to the prevalence of primary resistance in the population 1. In areas with high clarithromycin resistance, alternative therapies such as sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) or a 10-day levofloxacin-amoxicillin triple therapy may be considered 1. Overall, the treatment of gastritis caused by H. pylori requires a comprehensive approach that takes into account the latest evidence and guidelines, as well as the individual patient's needs and circumstances.

From the FDA Drug Label

Adult Patients only Helicobacter pyloriInfection 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 pyloriinfection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori. Dual therapy for H. pyloriwith lansoprazole : Amoxicillin, in combination with lansoprazole delayed-release capsules as dual therapy, is indicated for the treatment of patients with H pyloriinfection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) who are either allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected.

The guideline treatment for gastritis caused by Helicobacter pylori (H. pylori) includes:

• Triple therapy: Amoxicillin in combination with clarithromycin and lansoprazole to eradicate H. pylori.
• Dual therapy: Amoxicillin in combination with lansoprazole for patients who are allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected 2.

From the Research

Guideline Treatment for Gastritis

The guideline treatment for gastritis, especially when caused by Helicobacter pylori (H. pylori), typically involves a combination of medications.

• First-line therapy usually consists of a proton pump inhibitor (PPI) or ranitidine bismuth citrate (RBC) with any two antibiotics of amoxicillin, clarithromycin, or metronidazole given for 7-14 days 3.
• The choice of antibiotics may depend on the presence of antibiotic resistance, with clarithromycin being one of the most useful antimicrobials against H. pylori 4.
• In cases where first-line treatment fails, second-line therapy may involve a quadruple regimen composed of tetracycline, metronidazole, bismuth salts, and a PPI 3, or a levofloxacin-amoxicillin-based triple therapy given for 10 days 5.
• If second-line treatment also fails, a third-line treatment with a rifabutin-based regimen may be considered 5.

Treatment Options

Some studies have evaluated the effectiveness of different treatment regimens, including:

• A 5-day quadruple therapy with omeprazole, metronidazole, clarithromycin, and amoxicillin, which has been shown to be effective and safe for H. pylori eradication 6.
• A 10-day sequential regimen with a different combination of available antibiotics, which has been proposed to improve the eradication rate of triple therapy 5.
• The use of new drugs and adjuvant agents, such as lactoferrin and probiotics, which may help improve the eradication rate or minimize side effects 3.

Considerations

When treating H. pylori infection, it is essential to consider the potential for antibiotic resistance, which can reduce the effectiveness of treatment regimens 4, 7.

• Patient compliance is also crucial, as insufficient compliance can lead to treatment failure 7.
• In areas with high rates of clarithromycin and metronidazole resistance, bismuth-based quadruple therapy may be considered as a first-line regimen 7.