What are the dosages of amoxicillin, clarithromycin, and omeprazole (proton pump inhibitor) for a 14-day treatment of H. pylori infection?

H. pylori Treatment Regimen: Dosages for 14-Day Triple Therapy

For a 14-day H. pylori eradication treatment, the standard triple therapy consists of omeprazole 20 mg twice daily, amoxicillin 1000 mg twice daily, and clarithromycin 500 mg twice daily. 1

Standard Triple Therapy Dosing Details

Proton Pump Inhibitor (PPI)

• Omeprazole: 20 mg twice daily, 30 minutes before morning and evening meals
  • Note: Some guidelines suggest higher PPI doses may improve eradication rates
  • Standard dose is 20 mg, although double doses are sometimes used to increase success 1

Antibiotics

• Amoxicillin: 1000 mg (1 g) twice daily, 30 minutes after meals 1
• Clarithromycin: 500 mg twice daily 1

Duration and Administration

• All medications should be taken for the full 14 days
• Multiple guidelines (Toronto Consensus, Maastricht V/Florence, and ACG) recommend 14-day treatment duration for standard triple therapy to maximize eradication rates 1
• The medications should be taken consistently at the same times each day to maintain therapeutic levels

Important Considerations

Antibiotic Resistance

• Clarithromycin resistance is a growing concern that can reduce treatment efficacy
• In areas with high clarithromycin resistance (>15%), alternative regimens may be preferred 1
• If treatment fails, avoid reusing clarithromycin in subsequent regimens as resistance develops quickly after exposure 1

Compliance Factors

• Patient compliance is critical for successful eradication
• The twice-daily regimen has shown similar efficacy to more frequent dosing schedules while improving compliance 2
• Side effects are generally mild but may include gastrointestinal disturbances and altered taste 3

Alternative Regimens

If standard triple therapy is not appropriate due to antibiotic resistance or allergies:

1. Bismuth Quadruple Therapy:

   • PPI twice daily
   • Bismuth subsalicylate 262 mg (2 tablets) four times daily
   • Metronidazole 500 mg three-four times daily
   • Tetracycline 500 mg four times daily 1

2. Levofloxacin Triple Therapy (for second-line treatment):

   • PPI twice daily
   • Amoxicillin 1000 mg twice daily
   • Levofloxacin 500 mg once daily or 250 mg twice daily 1

Factors Affecting Treatment Success

• Smoking has been associated with lower eradication rates 4
• The degree of gastric inflammation may influence treatment success 4
• PPI metabolism varies based on CYP2C19 genotype, which may affect treatment efficacy 5

Remember that successful first-line treatment is crucial to prevent the development of antibiotic resistance and the need for more complex rescue therapies. The 14-day duration is strongly recommended to maximize eradication rates for this standard triple therapy regimen.