From the Guidelines
Triple therapy is a treatment regimen primarily used to eradicate Helicobacter pylori (H. pylori) infection, which causes peptic ulcers, gastritis, and is associated with gastric cancer. The standard triple therapy consists of a proton pump inhibitor (PPI) such as omeprazole (20mg twice daily) or lansoprazole (30mg twice daily), combined with two antibiotics—typically clarithromycin (500mg twice daily) and either amoxicillin (1g twice daily) or metronidazole (500mg twice daily)—taken for 7-14 days, as recommended by the most recent guidelines 1. Some key points to consider when using triple therapy include:
- The duration of treatment is often extended to 14 days in regions with high antibiotic resistance 1.
- Patients should complete the entire course of medication even if symptoms improve before finishing, take medications as scheduled with meals, avoid alcohol during treatment (especially with metronidazole), and be aware of possible side effects including nausea, diarrhea, and metallic taste.
- Follow-up testing 4-8 weeks after treatment completion is recommended to confirm eradication.
- In cases where triple therapy fails, alternative treatments such as bismuth-containing quadruple therapy or levofloxacin-based therapy may be considered, depending on the patient's specific situation and the local resistance patterns 1. It's also important 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.
From the FDA Drug Label
Duodenal Ulcer Associated with H. pylori Infection Clarithromycin + Lansoprazole and Amoxicillin H. pylori Eradication for Reducing the Risk of Duodenal Ulcer Recurrence Two U. S. randomized, double-blind clinical studies in patients with H. pylori and duodenal ulcer disease (defined as an active ulcer or history of an active ulcer within one year) evaluated the efficacy of clarithromycin in combination with lansoprazole and amoxicillin capsules as triple 14-day therapy for eradication of H. pylori Based on the results of these studies, the safety and efficacy of the following eradication regimen were established: Triple therapy: clarithromycin 500 mg b.i.d. + lansoprazole 30 mg b.i.d. + amoxicillin 1 gm b.i. d. Treatment was for 14 days. H. pylori eradication was defined as two negative tests (culture and histology) at 4 to 6 weeks following the end of treatment. The combination of clarithromycin plus lansoprazole and amoxicillin as triple therapy was effective in eradicating H. pylori. Eradication of H. pylori has been shown to reduce the risk of duodenal ulcer recurrence.
Triple therapy treats:
- H. pylori infection
- Duodenal ulcer disease (active or history of an active ulcer within one year) The goal of triple therapy is to eradicate H. pylori and reduce the risk of duodenal ulcer recurrence 2.
From the Research
Triple Therapy Treatment
Triple therapy is used to treat various conditions, including:
- Helicobacter pylori (H. pylori) infection, which can cause severe health problems such as gastritis, duodenal ulcer, and gastric ulcer 3, 4, 5, 6, 7
- Gastric and duodenal ulcers, with eradication rates of approximately 90% 4
- Bleeding peptic ulcers, with an overall ulcer healing rate of 97.1% and an eradication rate of 91.3% 7
Effectiveness of Triple Therapy
The effectiveness of triple therapy in treating H. pylori infection has been evaluated in several studies, with results showing:
- Per-protocol eradication rates of 80% and 80% for PPIAC and PPIAM regimens, respectively 3
- Eradication rates of approximately 86% with bismuth plus two antibiotics, but with a relatively high incidence of adverse effects 4
- Eradication rates of about 90% with proton-pump inhibitor triple therapy 4
- Compliance with prescribed medications as the most important factor predicting success, with a success rate of 96% for patients who took greater than 60% of the prescribed medications 6
Treatment Regimens
Various treatment regimens have been used in triple therapy, including: