From the Guidelines
The first-line treatment for Helicobacter pylori infection is standard triple therapy, which includes a proton pump inhibitor (PPI), clarithromycin, and amoxicillin, for 14 days, as recommended by recent guidelines 1. This regimen is the most commonly recommended and is based on the principle of using a combination of antibiotics to eradicate the infection. The standard triple therapy consists of a PPI, such as omeprazole, clarithromycin, and amoxicillin, taken for 14 days.
- The PPI should be taken at a standard dose, twice a day.
- Clarithromycin should be taken at a dose of 500mg, twice a day.
- Amoxicillin should be taken at a dose of 1000mg, twice a day. The choice of treatment should be guided by local antibiotic resistance patterns and patient factors, such as penicillin allergy.
- In areas with low clarithromycin resistance, standard triple therapy is recommended as the first-line treatment.
- In areas with high clarithromycin resistance, alternative regimens, such as bismuth quadruple therapy or non-bismuth quadruple therapy, may be considered. It is essential to complete the entire course of treatment, even if symptoms improve before completion, and to confirm eradication with a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after therapy completion and after PPI discontinuation for at least 2 weeks, as recommended by recent studies 1.
From the FDA Drug Label
Adult Patients only Helicobacter pylori Infection and Duodenal Ulcer Disease: Triple therapy for Helicobacter pylori (H. pylori) with clarithromycin and lansoprazole : Amoxicillin, in combination with clarithromycin plus lansoprazole as triple therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) to eradicate H. pylori. Dual therapy for H. pylori with lansoprazole : Amoxicillin, in combination with lansoprazole delayed-release capsules as dual therapy, is indicated for the treatment of patients with H pylori infection and duodenal ulcer disease (active or 1-year history of a duodenal ulcer) who are either allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected.
The first-line treatment for Helicobacter pylori (H. pylori) infection is triple therapy with:
- Amoxicillin
- Clarithromarin
- Lansoprazole as indicated for the treatment of patients with H. pylori infection and duodenal ulcer disease 2.
From the Research
First-Line Treatment for H. pylori Infection
The first-line treatment for Helicobacter pylori (H. pylori) infection includes:
- Concomitant nonbismuth quadruple therapy (proton pump inhibitor [PPI] + amoxicillin + metronidazole + clarithromycin [PAMC]) 3
- Traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline [PBMT]) 3
- PPI triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole) is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens 3
Treatment Duration
The consensus group strongly recommends that all H. pylori eradication regimens be given for 14 days 3
Alternative Therapies
Other studies have investigated alternative therapies, including:
- A combination of metronidazole, omeprazole, and clarithromycin, which was found to be effective in eradicating H. pylori infection in 88% of patients 4
- The use of amoxicillin and clavulanate, which was found to achieve a higher H. pylori eradication rate than amoxicillin alone 5
- A regimen consisting of omeprazole, amoxicillin, and either clarithromycin or metronidazole, which was found to be effective in eradicating H. pylori in Chinese peptic ulcer patients 6
- Dual therapy with omeprazole and amoxicillin, which was found to be effective in eradicating H. pylori in over 90% of patients 7