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

From the Guidelines

The standard first-line treatment for Helicobacter pylori infection is a 10-14 day course of triple therapy, consisting of a proton pump inhibitor (PPI), amoxicillin, and clarithromycin, if low clarithromycin resistance is present 1. This approach is based on the most recent and highest quality evidence, which prioritizes the eradication of H. pylori to prevent recurrent bleeding and reduce the risk of gastric cancer and other complications.

Key Considerations

• The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community 1.
• In areas with high clarithromycin resistance, alternative regimens such as sequential therapy or quadruple therapy may be considered 1.
• Treatment success should be confirmed with a urea breath test, stool antigen test, or endoscopy at least 4 weeks after completing therapy and after stopping PPI for at least 2 weeks.

Recommended Regimens

• Standard triple therapy: PPI, amoxicillin 1000mg twice daily, and clarithromycin 500mg twice daily for 10-14 days 1.
• Sequential therapy: PPI and amoxicillin for 5 days, followed by PPI, clarithromycin, and metronidazole for another 5 days 1.
• Quadruple therapy: PPI, amoxicillin, clarithromycin, and metronidazole for 10-14 days, or bismuth quadruple therapy for 14 days 1.

Important Notes

• Patients should complete the entire course of antibiotics even if symptoms improve and avoid alcohol during treatment, particularly when taking metronidazole.
• H. pylori eradication is important because the bacterium causes chronic gastritis and is associated with peptic ulcers, gastric cancer, and MALT lymphoma.

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.

The treatment for Helicobacter pylori (H. pylori) infection is a combination of clarithromycin, lansoprazole, and amoxicillin as a triple therapy for 14 days. The recommended dosages are:

• Clarithromycin: 500 mg twice a day
• Lansoprazole: 30 mg twice a day
• Amoxicillin: 1 gram twice a day This regimen has been shown to be effective in eradicating H. pylori and reducing the risk of duodenal ulcer recurrence 2.

From the Research

Treatment Options for H. pylori Infection

• The treatment for Helicobacter pylori (H. pylori) infection typically involves a combination of antibiotics and acid-suppressing medications 3, 4, 5, 6, 7.
• First-line treatment options often include a proton pump inhibitor (PPI) such as omeprazole, combined with antibiotics like clarithromycin and metronidazole 3, 4, 6.
• For patients allergic to penicillin, alternative treatment options may include a regimen with ranitidine bismuth citrate, tetracycline, and metronidazole, or a levofloxacin-based rescue regimen with a PPI and clarithromycin 3, 6.
• A 1-week course of famotidine, amoxicillin, and clarithromycin has also been shown to be an effective treatment option for H. pylori infection 5.

Efficacy of Treatment Options

• The efficacy of treatment options can vary, with per-protocol/intention-to-treat eradication rates ranging from 53% to 90% for different regimens 3, 4, 5, 6.
• Factors that can influence the response to H. pylori eradication therapy include bacterial resistance and patient compliance 7.
• Adverse events can occur with H. pylori treatment, with common side effects including nausea, diarrhea, and taste disturbance 4, 6, 7.

Rescue Options

• For patients who fail initial treatment, rescue options may include a levofloxacin-based regimen with a PPI and clarithromycin, which has been shown to be effective in eradicating H. pylori infection 3, 6.
• Other rescue options may include a regimen with rifabutin, clarithromycin, and a PPI, although this regimen has been shown to be less effective and poorly tolerated 3.