What are the brand name prescription medicines for Helicobacter pylori (H. pylori) infection?

Brand Name Prescription Medications for H. pylori Infection

The most effective brand name prescription medications for H. pylori infection include Talicia® (rifabutin-based triple therapy), Pylera® (bismuth quadruple therapy), and PPI-based combination regimens such as Prevpac® (lansoprazole, amoxicillin, and clarithromycin). 1, 2

First-Line Treatment Options

Bismuth Quadruple Therapy

• Pylera® - Contains bismuth subcitrate potassium, metronidazole, and tetracycline combined with a PPI
• Prevpac® - Contains lansoprazole, amoxicillin, and clarithromycin in a convenient package
• Omeclamox-Pak® - Contains omeprazole, clarithromycin, and amoxicillin

PPI Components (Brand Names)

• Nexium® (esomeprazole)
• Protonix® (pantoprazole)
• Prevacid® (lansoprazole)
• Prilosec® (omeprazole)
• Aciphex® (rabeprazole)

Treatment Selection Based on Antibiotic Resistance

Areas with Low Clarithromycin Resistance (<15%)

• Standard Triple Therapy (14 days): PPI (Nexium® or Aciphex®) + clarithromycin + amoxicillin 2
  • PPI (standard dose) twice daily
  • Clarithromycin 500mg twice daily
  • Amoxicillin 1000mg twice daily

Areas with High Clarithromycin Resistance (≥15%)

• Bismuth Quadruple Therapy (14 days): PPI + Pylera® 2
• Talicia® - FDA-approved rifabutin-based triple therapy containing rifabutin, amoxicillin, and omeprazole 1

Second-Line Treatment Options

If first-line treatment fails, options include:

• Levofloxacin-based triple therapy (in areas with low fluoroquinolone resistance) 2, 3

  • PPI (standard dose) twice daily
  • Levofloxacin 500mg once daily or 250mg twice daily
  • Amoxicillin 1000mg twice daily

• Rifabutin triple therapy (14 days) 1, 2

  • Rifabutin 150mg twice daily
  • Amoxicillin 1g three times daily
  • PPI (preferably esomeprazole or rabeprazole) 40mg twice daily

Important Considerations

1. PPI Selection: Higher-potency PPIs like Nexium® (esomeprazole) or Aciphex® (rabeprazole) at 40mg twice daily are more effective than lower-potency options 1

2. Treatment Duration: All regimens should be administered for 14 days to increase eradication rates by approximately 5% 2

3. Medication Timing: PPIs should be taken 30 minutes before meals on an empty stomach to maximize effectiveness 2

4. Confirmation of Eradication: Urea breath test or monoclonal stool antigen test should be performed at least 4 weeks after completing treatment, with PPIs discontinued at least 2 weeks before testing 2

5. Antibiotic Resistance: After two treatment failures, antimicrobial susceptibility testing should guide further treatment whenever possible 2, 4

Common Pitfalls to Avoid

1. Inadequate PPI Dosing: Using once-daily PPI instead of twice-daily reduces efficacy 2

2. Insufficient Treatment Duration: Less than 14 days results in lower eradication rates 2

3. Reusing Failed Antibiotics: Avoid using the same antibiotic after therapeutic failure, particularly clarithromycin 2

4. Ignoring Penicillin Allergy: For patients with penicillin allergy, bismuth-containing quadruple therapy is recommended as first-line treatment 2

5. Overlooking Drug Interactions: Be aware of potential interactions between PPIs and other medications 5

By following these evidence-based recommendations and selecting appropriate brand name medications, H. pylori eradication rates of over 80% can be achieved, reducing the risk of peptic ulcer disease recurrence and potential complications like gastric cancer.