From the Guidelines
The recommended treatment for H. pylori infection is a 14-day bismuth quadruple therapy as first-line therapy, which includes a proton pump inhibitor (PPI), bismuth subsalicylate, tetracycline, and metronidazole, due to increasing antibiotic resistance. This approach is supported by recent guidelines that prioritize quadruple therapies for initial treatment 1. The use of bismuth quadruple therapy is recommended when susceptibility testing or regional data are not available or for a non-invasive test, as it provides a high eradication rate and minimizes the risk of antibiotic resistance.
Key components of the treatment regimen include:
- A PPI, such as omeprazole, to reduce stomach acid production and create a less acidic environment for the antibiotics to work effectively
- Bismuth subsalicylate, which has antimicrobial properties and helps to protect the stomach lining
- Tetracycline, which is effective against H. pylori bacteria and helps to prevent resistance
- Metronidazole, which is effective against anaerobic bacteria and helps to prevent resistance
The treatment regimen should be tailored to the individual patient's needs and should take into account any allergies or intolerances to the medications. After completing treatment, patients should be tested to confirm eradication, typically using a urea breath test, stool antigen test, or endoscopy with biopsy at least 4 weeks after therapy and after stopping PPI for 2 weeks 1.
In areas with low clarithromycin resistance, standard triple therapy with a PPI, clarithromycin, and amoxicillin or metronidazole may be used as first-line therapy, but this approach is less preferred due to the increasing prevalence of antibiotic resistance 1. Sequential therapy with four drugs (amoxicillin, clarithromycin, metronidazole, and PPI) may be considered in selected cases, but this approach is not as effective as bismuth quadruple therapy in areas with high clarithromycin resistance 1.
Overall, the choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community and the individual patient's needs, with the goal of achieving high eradication rates and minimizing the risk of antibiotic resistance.
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 in adults is either triple therapy or dual therapy:
- 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
H. Pylori Treatment Options
The recommended treatment for H. Pylori infection typically involves a combination of antibiotics and acid suppression therapy. The following are some of the treatment options:
- Triple therapy: This regimen includes two antibiotics and a proton pump inhibitor (PPI) or ranitidine 3.
- Quadruple therapy: This regimen includes three antibiotics and a PPI, and has been shown to be effective in eradicating H. Pylori infection 4, 5, 6.
- Bismuth-containing quadruple regimens: These regimens include bismuth, two antibiotics, and a PPI, and have been shown to be effective in eradicating H. Pylori infection 5, 7, 6.
Treatment Regimens
Some specific treatment regimens that have been studied include:
- Amoxicillin, metronidazole, omeprazole, and clarithromycin for 5 days 4.
- Metronidazole, omeprazole, and clarithromycin for 2 weeks, followed by ranitidine for 4 weeks 3.
- Bismuth subcitrate potassium, metronidazole, tetracycline hydrochloride, and omeprazole for 10 days 5.
- Clarithromycin, tetracycline, and bismuth subsalicylate for 14 days 7.
- Lansoprazole, amoxicillin, metronidazole, and bismuth subsalicylate for 14 days 6.
Efficacy of Treatment Regimens
The efficacy of these treatment regimens has been studied in various clinical trials, with eradication rates ranging from 64.7% to 96% 4, 3, 5, 7, 6. The quadruple regimens, including those with bismuth, have been shown to be more effective than triple therapy in eradicating H. Pylori infection 5, 6.