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

From the Guidelines

The most effective treatment for Helicobacter pylori (H. pylori) infection is a combination of medications taken for 10-14 days, with the standard first-line therapy being triple therapy, which includes a proton pump inhibitor (PPI) such as omeprazole or pantoprazole, plus two antibiotics: amoxicillin and clarithromycin, as recommended by the most recent guidelines 1. The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community, with standard triple therapy recommended if low clarithromycin resistance is present 1. Some key points to consider when treating H. pylori infection include:

• The use of a PPI, such as omeprazole 20mg or pantoprazole 40mg, twice daily, to reduce stomach acid and help the antibiotics work more effectively 1
• The use of two antibiotics, such as amoxicillin 1000mg twice daily and clarithromycin 500mg twice daily, to kill the H. pylori bacteria 1
• The consideration of alternative therapies, such as quadruple therapy or sequential therapy, in cases where clarithromycin resistance is high or in patients who have failed previous treatment 1
• The importance of completing the full course of treatment, even if symptoms improve, to ensure eradication of the bacteria 1
• The need for follow-up testing, such as a urea breath test or stool antigen test, to confirm eradication of the bacteria at least 4 weeks after finishing antibiotics and while off PPI therapy for 2 weeks 1. It is also important to note that increasing antibiotic resistance is a major concern in the treatment of H. pylori infection, and local availability of susceptibility tests and regional and national monitoring programs are necessary to develop evidence-based locally relevant eradication strategies 1.

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 Infection

• The recommended first-line treatment for Helicobacter pylori infection is a proton pump inhibitor combined with amoxicillin and clarithromycin 3, 4, 5.
• Eradication rates with this regimen have been reported to be around 80-90% 6, 4, 7.
• However, rates of eradication are falling due to antibiotic resistance and poor compliance with therapy 3.
• Second-line treatment options include bismuth-based quadruple therapies and levofloxacin-based regimens 3, 6, 7, 5.
• Third-line options include regimes based on rifabutin or furazolidone, but susceptibility testing is recommended 3, 5.
• Sequential therapy is also a promising option, but needs further study and validation 4.

Factors Affecting Treatment Success

• Antibiotic resistance is a major cause of treatment failure 3, 6, 7, 5.
• Patient compliance is also crucial for successful treatment, with poor compliance leading to reduced eradication rates 3, 6, 5.
• The use of proton pump inhibitors (PPIs) has been shown to improve eradication rates 6, 4, 7.

Emerging Treatment Regimens

• New drugs and adjuvant agents have been reported, but their efficacy needs further evaluation 5.
• Quadruple therapy has been shown to be effective, with mean eradication rates of 96% 7.
• The use of quinolones and rifamycin derivatives has also been demonstrated to be effective in the treatment of H. pylori infection 4.