Can Mucosta (Rebamipide) Help with H. pylori Infection?
Mucosta (rebamipide) does NOT eradicate H. pylori infection on its own, but adding it to standard antibiotic-based eradication therapy modestly improves treatment success rates and may enhance healing quality. However, current international guidelines do not recommend rebamipide as a standard component of H. pylori eradication regimens, as the primary focus should be on optimizing the core antibiotic therapy itself 1.
Evidence for Rebamipide as an Adjunct to Eradication Therapy
A meta-analysis of 11 randomized controlled trials (1,227 patients) demonstrated that adding rebamipide to H. pylori eradication regimens significantly increased treatment effectiveness (OR 1.753,95% CI 1.312-2.333, p < 0.001) 2.
The benefit appears most pronounced when rebamipide is added to dual therapy regimens (OR 1.766,95% CI 1.167-2.495, p = 0.006), but the improvement was not statistically significant when added to triple therapy (OR 1.638,95% CI 0.833-3.219, p = 0.152) 2.
In a randomized study, adding rebamipide 300 mg daily to lansoprazole plus amoxicillin increased eradication rates from 57.4% to 75.0% (p < 0.05) 3, 4.
Another randomized trial showed eradication rates of 77.7% with standard triple therapy versus 81.8% when rebamipide was added, and 84% when rebamipide was continued for an additional 20 days post-eradication 5.
Mechanisms and Additional Benefits
Rebamipide reduces oxidative stress markers (malondialdehyde levels, myeloperoxidase activity) and inflammatory cytokines (IL-1, IL-6, TNF-alpha, IL-8) in H. pylori-infected gastric mucosa 3, 4.
The drug improves the quality of ulcer healing by reducing neutrophil infiltration in ulcer scars and promoting a flatter scar pattern, which may contribute to reduced ulcer recurrence 6.
Rebamipide significantly reduced inflammatory activity in the gastric antrum at 6 weeks post-treatment compared to standard therapy alone (inflammatory score 1.4±0.52 vs. 2±0.63, p=0.0399) 5.
Current Guideline Position
The American Gastroenterological Association and European guidelines state that probiotics and other adjunctive therapies (including mucosal protective agents) can be used to reduce side effects of eradication therapy, but there is no solid evidence they significantly increase eradication rates, and their use should be considered experimental 1.
The 2021 AGA clinical practice update emphasizes that the approach should focus on optimizing the primary antibiotic regimen—high-dose PPI use, 14-day treatment duration, and appropriate antibiotic selection—rather than functional supplementation 1.
Practical Recommendations
If you choose to use rebamipide as an adjunct:
Add rebamipide 100 mg three times daily to your standard eradication regimen (bismuth quadruple therapy or triple therapy) for the full 10-14 day treatment course 5.
Consider extending rebamipide for an additional 20 days after completing antibiotics to enhance mucosal healing and reduce inflammation, particularly in patients with gastric ulcers 5.
The addition of rebamipide does not increase adverse events (incidence remains around 20-24%) 5.
Critical priorities that matter more than rebamipide:
Use bismuth quadruple therapy for 14 days as first-line treatment (achieves 80-90% eradication even with antibiotic resistance) 1.
Use high-dose PPI twice daily (esomeprazole or rabeprazole 40 mg), which increases cure rates by 8-12% 1.
Ensure 14-day treatment duration, which improves eradication by approximately 5% compared to shorter regimens 1.
Avoid repeating antibiotics that failed previously, especially clarithromycin and levofloxacin 1.
Common Pitfall
Do not use rebamipide as monotherapy or as a substitute for proper antibiotic-based eradication therapy—it has no direct antibacterial activity against H. pylori and will not cure the infection 6. The drug's role is purely adjunctive to enhance the effectiveness of standard regimens and improve healing quality.