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, for 10-14 days, 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 ulcers. 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 regimens such as sequential therapy or levofloxacin-amoxicillin triple therapy may be considered 1. Key considerations in selecting a treatment regimen include:
- The prevalence of clarithromycin resistance in the local population
- The patient's history of antibiotic use and potential allergies
- The availability of alternative regimens and their potential efficacy It is essential to confirm treatment success 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 1. The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, and surveillance registries for H. pylori resistance and local therapy success rates should be mandatory to guide treatment decisions 1.
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 consisting of amoxicillin, clarithromycin, and lansoprazole, or dual therapy consisting of amoxicillin and lansoprazole, as specified in the dosing regimens above 2.
- 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.
From the Research
H pylori Treatment Options
- The recommended treatment for H pylori infection typically involves a combination of antibiotics and a proton pump inhibitor (PPI) 3, 4, 5.
- Triple therapy, consisting of two antibiotics, such as clarithromycin and amoxicillin or metronidazole, in combination with a PPI, has become the first-line option for infection with H pylori 5.
- However, due to increasing antibiotic resistance, alternative regimens such as concomitant and hybrid regimens have shown excellent results and could be the optimal treatment option 4.
- Bismuth-based quadruple therapy has also become a first-line regimen in areas with high rates of clarithromycin and metronidazole resistance, and is the preferred second-line option otherwise 5, 6.
Treatment Regimens
- A combination of metronidazole, omeprazole, and clarithromycin has been shown to be an effective treatment for H pylori infection, with a cure rate of 88% 3.
- A quadruple regimen of bismuth, metronidazole, and tetracycline plus omeprazole has been shown to produce a high eradication rate in subjects previously failing H pylori eradication regimens, with a cure rate of 93.2-93.8% 6.
- A new non-metronidazole therapy consisting of clarithromycin, tetracycline, and bismuth has been shown to be an effective treatment for H pylori infection, with a cure rate of 93% 7.
Considerations
- The choice of treatment regimen depends on factors such as the local pattern of antibiotic resistance, drug availability, and previous treatment 4.
- Antibiotic resistance testing is recommended after multiple eradication failures 5.
- Patient compliance and antibiotic resistance are major causes of treatment failure 5.