What are the commonly prescribed treatments for gastritis?

Common Treatments for Gastritis

Proton pump inhibitors (PPIs) are the first-line treatment for gastritis, with high-potency options like esomeprazole or rabeprazole (20-40 mg twice daily) being most effective for symptom relief and healing. 1

First-Line Treatments

Proton Pump Inhibitors (PPIs)

• PPIs are the most potent gastric acid-suppressing agents available and are superior to H2-receptor antagonists for treating gastritis 2
• Recommended PPI options in order of potency:
  • Rabeprazole: 20 mg twice daily (36 mg equivalent of omeprazole) 1
  • Esomeprazole: 20-40 mg twice daily (32 mg equivalent of omeprazole) 1
  • Lansoprazole: 30 mg twice daily (27 mg equivalent of omeprazole) 1
  • Omeprazole: 20-40 mg twice daily 3
• Pantoprazole should be avoided when possible due to lower potency (40 mg pantoprazole = 9 mg omeprazole) 1

H2-Receptor Antagonists

• Less effective than PPIs but still useful, especially for mild cases or as step-down therapy 1
• Options include:
  • Ranitidine: 5-10 mg/kg/day divided in 2-3 doses 1
  • Famotidine: 1 mg/kg/day divided in 2 doses 1
  • Cimetidine: 30-40 mg/kg/day divided in 4 doses 1

Treatment for H. pylori-Associated Gastritis

H. pylori infection is a major cause of gastritis and requires specific treatment regimens:

Recommended First-Line Regimens

• Bismuth quadruple therapy (14 days) is now preferred over clarithromycin triple therapy due to increasing antibiotic resistance 1
• Alternative first-line option when bismuth is unavailable:
  • Concomitant 4-drug therapy 1

Triple Therapy Options (when susceptibility is known)

• Clarithromycin triple therapy (14 days): Clarithromycin 500 mg twice daily, amoxicillin 1 g twice daily, plus PPI 1
• Metronidazole triple therapy (14 days): Metronidazole 500 mg twice daily, amoxicillin 1 g twice daily, plus PPI 1
• Levofloxacin triple therapy (14 days): Levofloxacin 500 mg in morning, amoxicillin 1 g twice daily, plus PPI 1

Important Considerations for H. pylori Treatment

• Local resistance patterns should guide therapy selection 1
• Antibiotics used in failed treatment attempts should be avoided in subsequent regimens 1
• Higher-potency PPIs (rabeprazole or esomeprazole) improve eradication rates 1

Adjunctive Treatments

Antacids

• Provide rapid, temporary relief of symptoms 1
• Can be used on-demand for breakthrough symptoms 1
• Should be administered separately from other medications to avoid interaction 4, 3

Gastroprotective Agents

• Misoprostol (synthetic PGE1): Reduces NSAID-associated gastric ulcers by 74% and duodenal ulcers by 53% 1
  • Side effects include diarrhea, abdominal pain, and nausea, limiting widespread use 1

Special Considerations

NSAID-Induced Gastritis

• Use the lowest effective NSAID dose for the shortest duration 1
• Add PPI therapy for gastroprotection in high-risk patients 1
• Consider H. pylori eradication before starting long-term NSAID therapy 1

Common Pitfalls to Avoid

• Inadequate PPI dosing: Higher doses are often needed for effective treatment 1
• Premature discontinuation: Treatment should continue until symptoms resolve completely 1
• Failure to address H. pylori: Testing and treating H. pylori is essential in appropriate cases 1
• Drug interactions: PPIs may interact with medications like clopidogrel; consider this when selecting therapy 4, 3

Treatment Duration

• Acute gastritis: 4-8 weeks of PPI therapy 2
• H. pylori eradication: 10-14 days of combination therapy 1
• Maintenance therapy may be required for recurrent or severe cases 1