From the Guidelines
The standard first-line therapy for H. pylori infection is triple therapy, which includes a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, plus two antibiotics: clarithromycin 500mg twice daily and either amoxicillin 1000mg twice daily or metronidazole 500mg twice daily, as recommended by the most recent guidelines 1.
Treatment Options
The treatment for H. pylori infection typically involves a combination of medications taken for 10-14 days. The goal of treatment is to eradicate the bacteria and reduce the risk of complications such as gastritis, peptic ulcers, and gastric cancer.
- Triple therapy is the standard first-line treatment, which includes a PPI, clarithromycin, and either amoxicillin or metronidazole.
- Quadruple therapy is another option, which adds bismuth subsalicylate to the regimen.
- Sequential therapy (5 days of PPI plus amoxicillin, followed by 5 days of PPI plus clarithromycin and metronidazole) may be considered in cases of high clarithromycin resistance.
Importance of Completing Treatment
It is crucial to complete the entire course of treatment, even if symptoms improve before finishing, to ensure complete eradication of the bacteria.
Follow-up Testing
After treatment, testing to confirm eradication is usually recommended, typically 4 weeks after completing antibiotics and after stopping PPIs for 2 weeks.
Antibiotic Resistance
Increasing antibiotic resistance is a concern, and treatment recommendations may need to be adjusted based on local resistance patterns and individual patient factors, as highlighted in recent studies 2, 3, 4, 5.
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: Amoxicillin in combination with clarithromycin and lansoprazole
- Dual therapy: Amoxicillin in combination with lansoprazole (for patients allergic or intolerant to clarithromycin or with known/suspected resistance to clarithromycin) 6
From the Research
Treatment Options for Helicobacter pylori (H. pylori) Infection
The treatment for H. pylori infection typically involves a combination of medications, including:
- Proton pump inhibitors (PPIs) to reduce stomach acid
- Antibiotics to kill the bacteria Some common treatment regimens include:
- Triple therapy with a PPI, amoxicillin, and clarithromycin or metronidazole 7, 8, 9, 10
- Quadruple therapy with a PPI, bismuth, tetracycline, and metronidazole 7, 9, 10
- Levofloxacin-based triple therapy as an alternative to conventional triple therapy 10, 11
Factors Affecting Treatment Effectiveness
The effectiveness of H. pylori treatment can be influenced by several factors, including:
- Antibiotic resistance, particularly to clarithromycin and metronidazole 8, 9, 10, 11
- Patient compliance with the treatment regimen 10
- Dosage and duration of PPI therapy 7
- Age and other patient characteristics, such as the presence of comorbidities 8
Recommended Treatment Regimens
Based on the available evidence, the following treatment regimens are recommended:
- First-line treatment: high-dose PPIs in 14-day triple therapy or 10- or 14-day quadruple concomitant therapy 7
- Second-line treatment: metronidazole-tetracycline-bismuth quadruple therapy or levofloxacin-amoxicillin triple therapy 7, 11
- Alternative regimens: levofloxacin-based triple therapy or bismuth-based quadruple therapy 10, 11