From the Guidelines
Triple therapy for H. pylori infection, as recommended, consists of a proton pump inhibitor (PPI) such as omeprazole 20 mg or equivalent twice daily, clarithromycin 500 mg twice daily, and amoxicillin 1 gram twice daily, all administered for 14 days, as this regimen is effective in areas where clarithromycin resistance is low (less than 15%) 1. This recommendation is based on the most recent and highest quality evidence available, which prioritizes the reduction of morbidity, mortality, and improvement of quality of life for patients with H. pylori infection.
Key Components of Triple Therapy
- PPI: reduces gastric acid secretion, creating a less acidic environment that enhances antibiotic efficacy and provides symptom relief
- Clarithromycin: inhibits bacterial protein synthesis
- Amoxicillin: disrupts bacterial cell wall formation
Considerations for Patients with Penicillin Allergy
For patients with penicillin allergy, metronidazole 500 mg twice daily can be substituted for amoxicillin, as recommended by recent guidelines 1.
Importance of Eradication Confirmation
Eradication should be confirmed 4-8 weeks after therapy completion using either a urea breath test, stool antigen test, or endoscopic biopsy, and importantly, PPI therapy should be discontinued 2 weeks before testing to avoid false-negative results.
Second-Line Options
If this first-line therapy fails, quadruple therapy or bismuth-based regimens are typically considered as second-line options, taking into account local antibiotic resistance patterns, as suggested by recent studies 1.
From the FDA Drug Label
- 4 Dosage for H. pyloriInfection in Adults Triple therapy:The recommended adult oral dose is 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 H. pylori infection is:
- 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 is based on the combination of two antibiotics and a proton pump inhibitor (PPI). The following are some of the triple therapy regimens that have been studied:
- Clarithromycin triple therapy: clarithromycin, PPI, and amoxicillin or metronidazole 3
- Omeprazole, amoxycillin, and clarithromycin (OAC) 4
- Omeprazole, amoxycillin, and metronidazole (OAM) 4
- Metronidazole, omeprazole, and clarithromycin 5
Components of the Triple Therapy Regimen
The components of the triple therapy regimen may vary, but they typically include:
- A PPI, such as omeprazole, to reduce stomach acid and create a less acidic environment for the antibiotics to work effectively
- An antibiotic, such as clarithromycin or metronidazole, to kill the H. pylori bacteria
- A second antibiotic, such as amoxicillin, to enhance the effectiveness of the first antibiotic and reduce the risk of resistance
Efficacy of the Triple Therapy Regimen
The efficacy of the triple therapy regimen has been studied in several clinical trials, with reported eradication rates ranging from 78% to 96% 6, 7, 5, 4. The choice of antibiotics and PPI may affect the efficacy of the regimen, and the presence of antibiotic resistance may reduce the effectiveness of the treatment 3, 7.