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

From the Guidelines

The recommended treatment for Helicobacter pylori infection is a combination therapy approach, with first-line treatment typically consisting of a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, combined with two antibiotics: amoxicillin 1g twice daily and clarithromycin 500mg twice daily for 14 days, as supported by the most recent study 1.

Key Considerations

• The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, as noted in 1 and 1.
• In areas with low clarithromycin resistance, standard triple therapy is recommended as first-line therapy, as stated in 1 and 1.
• For patients allergic to penicillin, metronidazole 500mg twice daily can replace amoxicillin, as mentioned in the example answer.
• If the initial treatment fails, a 10-day levofloxacin-amoxicillin triple therapy is recommended as second-line therapy, as suggested in 1.

Treatment Regimens

• Standard triple therapy: PPI, amoxicillin, and clarithromycin for 14 days, as recommended in 1 and 1.
• Sequential therapy: PPI and amoxicillin for the first 5 days, followed by PPI, clarithromycin, and metronidazole for the next 5 days, as mentioned in 1.
• Levofloxacin-amoxicillin triple therapy: PPI, levofloxacin, and amoxicillin for 10 days, as recommended in 1.

Important Notes

• Confirmation of eradication should be performed at least 4 weeks after completing therapy using either a urea breath test, stool antigen test, or endoscopic biopsy, as noted in the example answer.
• Patients should avoid alcohol during treatment due to potential interactions with metronidazole, as mentioned in the example answer.
• H. pylori eradication is important because the bacterium causes chronic gastritis and is associated with peptic ulcer disease, gastric cancer, and MALT lymphoma, as stated in the example answer.

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. Dual therapy for H. pylori with lansoprazole : Amoxicillin, in combination with lansoprazole delayed-release capsules as dual 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) who are either allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected.

The treatment for Helicobacter pylori (H. pylori) infection is:

• Triple therapy: Amoxicillin in combination with clarithromycin and lansoprazole
• Dual therapy: Amoxicillin in combination with lansoprazole (for patients allergic or intolerant to clarithromycin or with known/suspected resistance to clarithromycin) 2

From the Research

Treatment Options for Helicobacter pylori (H. pylori) Infection

• The treatment of H. pylori infection typically involves a combination of proton pump inhibitors (PPIs) and antibiotics 3, 4, 5, 6, 7.
• The goal of treatment is to eradicate the bacterium from the foregut, which can be challenging due to its habitat and acquired resistance to commonly used antibiotics 7.
• First-line treatment options include:
  • Concomitant nonbismuth quadruple therapy (PPI + amoxicillin + metronidazole + clarithromycin) 4.
  • Traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline) 4.
  • PPI triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole), although this is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens 4.
• Second-line treatment options include:
  • Metronidazole-tetracycline-bismuth quadruple therapy for 14- and 10-days with standard and high-dose PPIs, respectively 3.
  • Levofloxacin-amoxicillin triple therapy for 14-days with high-dose PPIs 3.
• The duration of treatment is typically 10-14 days, with 14-day therapies showing higher eradication rates 3, 4.
• The use of high-dose PPIs is recommended in first-line treatment, particularly in 14-day triple therapy and 10- or 14-day quadruple concomitant therapy 3.
• In cases of clarithromycin resistance, metronidazole-based regimens may be more effective 6.

Antibiotic Regimens

• Amoxicillin, clarithromycin, and metronidazole are commonly used antibiotics in H. pylori treatment regimens 3, 4, 5, 6.
• Tetracycline and doxycycline may also be effective, although their use is less common 5.
• Fluoroquinolones, such as levofloxacin, may be used as an alternative to clarithromycin or amoxicillin, although resistance rates are increasing 5, 6.
• Bismuth can be used in combination with antibiotics, although its value is poorly documented and it can cause encephalopathy 5.