From the Guidelines
The triple therapy regimen for Helicobacter pylori (H. pylori) infection typically consists of a proton pump inhibitor (PPI) plus two antibiotics taken for 10-14 days, with the standard regimen including omeprazole 20mg twice daily, amoxicillin 1g twice daily, and clarithromycin 500mg twice daily, as recommended by recent guidelines 1.
Key Components of Triple Therapy
- A proton pump inhibitor (PPI) to reduce stomach acid and increase the effectiveness of antibiotics
- Two antibiotics, typically amoxicillin and clarithromycin, to target the H. pylori bacteria directly
Alternative Regimens
- For patients with penicillin allergy, metronidazole 500mg twice daily can replace amoxicillin 1
- Levofloxacin triple therapy (levofloxacin 500mg once daily or 250mg twice daily, amoxicillin 1g twice daily, and PPI) is recommended as second-line therapy if first-line therapy fails 1
Treatment Duration and Dosing
- Treatment duration is typically 10-14 days, with 14 days being the preferred length of first-line therapy 1
- Standard dosing for PPI, amoxicillin, clarithromycin, and metronidazole is as follows:
- PPI: standard dose twice daily (e.g. omeprazole 20mg twice daily)
- Amoxicillin: 1000mg twice daily
- Clarithromycin: 500mg twice daily
- Metronidazole: 500mg twice daily
Importance of Compliance and Follow-up
- Patients should complete the entire course of treatment even if symptoms improve before finishing
- Eradication should be confirmed with either a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after completing therapy and while off PPI therapy for at least 2 weeks 1
From the FDA Drug Label
Dosing for H. pyloriInfection (in Adults): Triple therapy: 1 gram amoxicillin, 500 mg clarithromycin, and 30 mg lansoprazole, all given twice daily (every 12 hours) for 14 days.
The triple therapy regimen for Helicobacter pylori (H. pylori) infection consists of:
- Amoxicillin: 1 gram, twice daily
- Clarithromycin: 500 mg, twice daily
- Lansoprazole: 30 mg, twice daily All given for 14 days 2.
From the Research
Triple Therapy Regimen for H. pylori Infection
The triple therapy regimen for Helicobacter pylori (H. pylori) infection typically consists of a combination of medications, including:
- A proton pump inhibitor (PPI) such as omeprazole or lansoprazole
- An antibiotic such as amoxicillin or metronidazole
- Another antibiotic such as clarithromycin
Examples of Triple Therapy Regimens
Some examples of triple therapy regimens for H. pylori infection include:
- Omeprazole, amoxicillin, and clarithromycin (OAC) 3
- Omeprazole, amoxicillin, and metronidazole (OAM) 3
- Lansoprazole, clarithromycin, and amoxicillin 4
- Levofloxacin, amoxicillin, and lansoprazole (ALL) 5
Duration and Efficacy of Triple Therapy Regimens
The duration of triple therapy regimens for H. pylori infection is typically 7-14 days, with eradication rates ranging from 78% to 92% 3, 4. However, the efficacy of these regimens can be affected by factors such as antibiotic resistance and patient compliance. According to 6, PPI triple therapy is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens.
Considerations for Treatment
It is essential to consider local antibiotic resistance patterns and eradication rates when selecting a triple therapy regimen for H. pylori infection 6. Additionally, patients who have failed previous treatments may require alternative regimens, such as levofloxacin-containing triple therapy 5.