What is the treatment for Helicobacter pyli (H. pyli) infection?

From the Guidelines

The most effective treatment for Helicobacter pylori infection is 14-day bismuth quadruple therapy as first-line therapy when susceptibility testing or regional data are not available or for a non-invasive test. This approach is based on the principles of antibiotic stewardship and has been recommended in recent guidelines due to increasing antibiotic resistance 1. The treatment typically involves a combination of a proton pump inhibitor (PPI), bismuth subsalicylate, tetracycline, and metronidazole.

Key Considerations

• The choice of treatment should be based on regional microbial ecology and antibiotic resistance patterns 1.
• In areas with high clarithromycin resistance, bismuth quadruple therapy is recommended 1.
• Treatment success depends on patient adherence, antibiotic resistance patterns, and proper acid suppression to allow antibiotics to work effectively in the stomach environment 1.
• After completing treatment, patients should be tested to confirm eradication, typically using a urea breath test, stool antigen test, or endoscopic biopsy at least 4 weeks after therapy and after PPI discontinuation for at least 2 weeks 1.

Special Considerations

• For patients with gastric MALT lymphoma, H. pylori eradication therapy should be given to all patients, and 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 localized H. pylori-positive gastric MALT lymphoma, the initial treatment should be H. pylori eradication, which can induce lymphoma regression and long-term clinical disease control in three-quarters of patients 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 treatment for Helicobacter pylori (H. pylori) infection is:

• Triple therapy: a combination of amoxicillin, clarithromycin, and lansoprazole to eradicate H. pylori in patients with H. pylori infection and duodenal ulcer disease.
• Dual therapy: a combination of amoxicillin and lansoprazole for patients who are allergic or intolerant to clarithromycin or in whom resistance to clarithromycin is known or suspected 2. Alternatively, omeprazole can be used in combination with clarithromycin and amoxicillin as triple therapy, or in combination with clarithromycin as dual therapy for the treatment of H. pylori infection and duodenal ulcer disease 3.

From the Research

Treatment Options for Helicobacter pyli (H. pyli) Infection

• The treatment for H. pyli infection typically involves antibiotic therapy, with the goal of eradicating the bacterium from the foregut 4.
• Current treatment options include:
  • Proton-pump inhibitor and amoxicillin-based triple therapy containing clarithromycin (PAC) or metronidazole (PAM) 5.
  • Bismuth-containing quadruple therapy 6, 7, 8.
  • Concomitant therapy 6, 8.
  • Sequential therapy, although this is no longer a suggested treatment by international guidelines 8.
• The choice of treatment regimen depends on various factors, including:
  • Local resistance patterns 6, 8.
  • Patient's previous exposure to antibiotics 8.
  • Presence of clarithromycin or metronidazole resistance 5, 6.
• Treatment regimens may vary in terms of duration, with some lasting 7-10 days and others lasting 14 days 5, 7, 8.
• The use of high-dose proton-pump loader and avoiding repeating the same regimen if it has already failed are general rules to optimize the management of H. pyli infection 8.

Efficacy of Treatment Regimens

• The efficacy of PAC and PAM regimens has been shown to be comparable, with pooled risk ratios (RR) of 0.96 and 1.02, respectively 5.
• PAM has been shown to be highly effective in clarithromycin-resistant cases, with an RR of 0.65 5.
• PAC has been shown to be effective in metronidazole-resistant cases, with an RR of 1.43 5.
• Bismuth quadruple therapy and concomitant therapy have been shown to be effective first-line empirical treatments in areas with high clarithromycin resistance 6, 8.