From the Guidelines
Treated Helicobacter pylori (H. pylori) is called H. pylori eradication therapy. This typically consists of a combination of medications including two antibiotics plus a proton pump inhibitor (PPI), often referred to as triple therapy. Common antibiotic combinations include clarithromycin with either amoxicillin or metronidazole, along with a PPI such as omeprazole, lansoprazole, or esomeprazole, as recommended by the most recent guidelines 1. The standard duration is 10-14 days.
Key Considerations
- In areas with high clarithromycin resistance, quadruple therapy may be used, which adds bismuth subsalicylate to the regimen 1.
- After completing treatment, patients should be tested to confirm eradication, usually with a urea breath test, stool antigen test, or endoscopic biopsy 1.
- The goal of treatment is to achieve complete eradication of H. pylori to prevent recurrence of symptoms and reduce long-term complications, including peptic ulcers, gastritis, and gastric cancer.
Treatment Approach
- The treatment approach should be based on regional microbial ecology and resistance patterns, with the choice of antibiotics guided by susceptibility testing when possible 1.
- Second-line therapies should be bismuth quadruple therapy or levofloxacin triple therapy, depending on suspected resistance, reserving rifabutin-based triple and high-dose dual amoxicillin proton pump inhibitor therapy for subsequent treatment attempts 1.
Monitoring and Follow-up
- The outcome of eradication therapy should be checked by a urea breath test (or by a monoclonal stool antigen test) at least 6 weeks after starting eradication therapy and at least 2 weeks after PPI withdrawal 1.
- In patients who achieve clinical and endoscopic remission with eradication of H. pylori but have persistent microscopic lymphoma on histology, it is reasonable to wait for at least 12 months before considering further treatment 1.
From the Research
Treated Helicobacter pylori (H. pylori)
- The term used to describe treated H. pylori is "eradicated" 2, 3, 4, 5, 6
- Eradication of H. pylori is the goal of therapy, and it can be achieved through various treatment regimens, including triple therapy, quadruple therapy, and concomitant therapy 2, 3, 5, 6
- The choice of treatment regimen depends on several factors, including the patient's medical history, antibiotic resistance, and the presence of special conditions such as penicillin allergies or pregnancy 2, 4, 5
- Eradication rates can vary depending on the treatment regimen and patient population, with some studies reporting eradication rates of up to 96% 6
- Verification of eradication can be done through various tests, including stool antigen tests and urea breath tests 4, 6