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 10-14 day course of standard triple therapy, which includes a proton pump inhibitor (PPI) and two antibiotics, such as amoxicillin and clarithromycin, in areas with low clarithromycin resistance 1. This approach is supported by recent guidelines, which recommend triple therapy as the first-line treatment for H. pylori infection, with the option to switch to quadruple therapy or other regimens in cases of high clarithromycin resistance or treatment failure 1. Some key points to consider when treating H. pylori infection include:

• The choice of treatment regimen should be based on the knowledge of the underlying prevalence of resistant strains in the community 1
• Patients should complete the full course of treatment, even if symptoms improve before finishing
• After 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 completing antibiotics and 2 weeks after stopping PPIs
• H. pylori eradication is crucial because the bacterium causes chronic gastritis and is associated with peptic ulcers, gastric cancer, and MALT lymphoma
• During treatment, patients should avoid alcohol, especially when taking metronidazole, and may experience side effects like diarrhea, nausea, and metallic taste In areas with high clarithromycin resistance, alternative regimens such as quadruple therapy or sequential therapy may be used as first-line treatment 1. It's also important to note that the treatment of H. pylori infection has evolved in recent years, with a shift towards a more proactive approach to testing and treatment, including outreach to family members of individuals diagnosed with active infection and high-risk local populations 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 (H. pylori) Infection

The treatment for H. pylori infection typically involves a combination of medications, including:

• Proton pump inhibitors (PPIs) to reduce stomach acid
• Antibiotics to kill the bacteria Some common treatment regimens include:
• Triple therapy: a combination of two antibiotics (such as clarithromycin and amoxicillin or metronidazole) and a PPI 3
• Quadruple therapy: a combination of two antibiotics, a PPI, and bismuth subsalicylate 4, 3
• Sequential therapy: a combination of two antibiotics and a PPI, taken in a specific sequence 5

First-Line Treatment

First-line treatment options for H. pylori infection include:

• 14-day triple therapy with clarithromycin, amoxicillin, and a PPI 6, 7
• 10-day or 14-day quadruple therapy with bismuth subsalicylate, two antibiotics, and a PPI 6, 5
• 14-day clarithromycin-containing triple therapy in areas with low prevalence of clarithromycin resistance and in patients without previous use of macrolides 5

Second-Line Treatment

Second-line treatment options for H. pylori infection include:

• Levofloxacin-containing triple therapy 4, 5
• Bismuth quadruple therapy 3, 5
• A 10-day fluoroquinolone-based regimen consisting of a PPI, levofloxacin, and either clarithromycin or amoxicillin 4

Considerations

When choosing a treatment regimen, considerations should include:

• Local prevalence of clarithromycin resistance 5
• Previous use of macrolides 5
• Patient compliance and potential antibiotic resistance 3
• Use of probiotic supplementation to reduce antibiotic-related adverse events 5