Mucosta (Rebamipide) is NOT a Primary Treatment for H. pylori Infection
Mucosta (rebamipide) is a mucoprotective agent that cannot eradicate H. pylori as monotherapy and should never be used as primary treatment for H. pylori infection. The standard of care requires antibiotic-based eradication regimens, with bismuth quadruple therapy being the preferred first-line approach 1, 2.
Why Mucosta Cannot Replace Standard H. pylori Treatment
H. pylori eradication requires antibiotics. The American Gastroenterological Association recommends bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline) for 14 days as first-line treatment, achieving 80-90% eradication rates 1, 2.
Rebamipide has no direct antibacterial activity against H. pylori. It is a gastroprotective drug that enhances mucosal defense mechanisms but does not kill the bacteria 3, 4.
Untreated H. pylori infection leads to serious complications. Without eradication, patients remain at risk for peptic ulcer disease, gastric cancer, and MALT lymphoma 5, 1.
What the Evidence Actually Shows About Rebamipide
Limited Role as an Adjunctive Agent (Not Primary Treatment)
Older studies from 1998 showed that adding rebamipide to dual therapy (PPI + amoxicillin) increased eradication rates from 51.7% to 73.3% 3.
A 2019 meta-analysis demonstrated that rebamipide supplementation improved eradication rates when added to dual therapy regimens (OR 1.766), but showed no significant benefit when added to triple therapy (OR 1.638, p=0.152) 6.
Critical limitation: These studies used outdated dual therapy regimens that are no longer recommended. Modern guidelines mandate triple or quadruple therapy, where rebamipide shows no proven benefit 6.
Why Rebamipide is Not Included in Current Guidelines
No major guideline recommends rebamipide for H. pylori eradication. The Maastricht IV/Florence Consensus, American Gastroenterological Association, and American College of Gastroenterology guidelines do not include rebamipide in any recommended regimen 5, 1, 2.
The evidence for rebamipide is classified as low-level (Grade D) and considered experimental 1.
Modern eradication regimens achieve 80-90% success rates without rebamipide, making its addition unnecessary 1, 2.
The Correct Approach to H. pylori Treatment
First-Line Treatment
Bismuth quadruple therapy for 14 days is the gold standard: high-dose PPI twice daily + bismuth subsalicylate + metronidazole + tetracycline 1, 2.
This regimen achieves 80-90% eradication even against clarithromycin and metronidazole-resistant strains 1, 2.
Use high-potency PPIs (esomeprazole or rabeprazole 40 mg twice daily) to increase cure rates by 8-12% 1.
Alternative First-Line (Only in Low Resistance Areas)
Triple therapy (PPI + clarithromycin + amoxicillin for 14 days) may be considered only in areas with documented clarithromycin resistance <15% 5, 1.
Most regions now exceed this threshold, making bismuth quadruple therapy the preferred choice 1.
Confirmation of Eradication is Mandatory
Test for eradication success at least 4 weeks after completing therapy using urea breath test or monoclonal stool antigen test 5, 1, 2.
Discontinue PPI at least 2 weeks before testing 1.
Never use serology to confirm eradication—antibodies persist long after successful treatment 1.
Critical Pitfalls to Avoid
Never use rebamipide as monotherapy for H. pylori—it will not eradicate the infection and delays appropriate treatment 3, 4.
Do not substitute rebamipide for antibiotics in eradication regimens—this represents substandard care 1, 2.
Avoid dual therapy regimens (PPI + single antibiotic) even with rebamipide—they are obsolete and achieve inadequate eradication rates 6.
Do not assume rebamipide improves modern triple/quadruple therapy—the evidence does not support this, and guidelines do not recommend it 1, 6.