From the Guidelines
The recommended treatment for H. pylori infection is a standard triple therapy regimen consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin, which is recommended as first-line therapy if low clarithromycin resistance is present 1. This approach is based on the most recent and highest quality evidence, which suggests that standard triple therapy is effective in eradicating H. pylori infection and preventing recurrent bleeding in patients with bleeding peptic ulcer and positive tests for HP infection. The recommended doses are:
- PPI standard dose twice a day
- Clarithromycin 500 mg twice a day
- Amoxicillin 1000 mg twice a day In areas with high clarithromycin resistance or after failed first-line therapy, alternative therapies such as sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) or levofloxacin-based triple therapy (PPI, amoxicillin, and levofloxacin) may be considered 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, and the treatment should be tailored to the individual patient's needs and circumstances. The goal of treatment is to eradicate H. pylori infection, which can help to prevent complications such as peptic ulcers and gastric cancer, and improve quality of life. Eradication should be confirmed with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing therapy and after stopping PPI for at least 2 weeks.
From the FDA Drug Label
2.4 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: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily for 14 days.
- Dual therapy: 1 gram amoxicillin and 30 mg lansoprazole, each given three times daily for 14 days 2.
From the Research
Treatment Options for H pylori Infection
The recommended treatment for H pylori infection typically involves a combination of medications to achieve complete eradication of the bacteria. The following treatment options are available:
- First-line therapy:
- Second-line therapy:
- Rescue therapy:
- Quadruple regimen of bismuth, metronidazole, and tetracycline plus omeprazole, which produces a high eradication rate in subjects previously failing H. pylori eradication regimens 5
Proton Pump Inhibitors (PPIs) in H pylori Treatment
Different PPIs, such as omeprazole, lansoprazole, and pantoprazole, have been compared in combination with amoxicillin and clarithromycin for the first-line eradication of H pylori 6. The eradication rates were found to be similar among the different PPIs, with an overall eradication rate of 45% 6. Another study evaluated the efficacy of a 1-week triple therapy with omeprazole, amoxycillin, and clarithromycin, which resulted in a cure rate of 77% 7.
Considerations for Treatment Selection
The choice of treatment regimen should be based on local resistance patterns and patient-specific factors, such as antibiotic allergies and potential interactions with other medications 3, 4. Additionally, the treatment regimen should be selected based on the patient's previous treatment history and the presence of any underlying medical conditions 3, 4.