H. pylori  Treatment Options 1

Test it.

The first step in addressing H. pylori is to perform a test that is easily accessible, covered by insurance, and highly accurate–like the Meridian HpSA® Tests.

Treat it.

Once H. pylori is detected, initiate treatment. Because all treatments are comparable in terms of efficacy, consider the following when initiating treatment1:

  • Cost
  • Tolerability
  • Ease of administration
  • Patient adherence

Suggested Regimens for the Treatment of Helicobacter pylori  Infection

Although several treatment regimens for H. pylori  infection have been identified, none has yet emerged as superior. Variables such as cost, tolerability, ease of administration, and patient adherence should be considered when prescribing therapy.1

First-line therapy

Standard triple therapy

PPI (standard dose, bid), clarithromycin (500 mg, bid) and amoxicillin (1 g, bid) for 7–14 days

Concomitant therapy

PPI (standard dose, bid), clarithromycin (500 mg, bid), amoxicillin (1 g, bid) and metronidazole (500 mg, bid)
for 7–10 days

Hybrid therapy

7-day dual therapy with a PPI (standard dose, bid) and amoxicillin (1 g, bid) followed by a 7-day quadruple therapy with a PPI (standard dose, bid), amoxicillin (1 g, bid), clarithromycin (500 mg, bid), and metronidazole (500 mg, bid)

Bismuth-containing quadruple therapy

PPI (standard dose, bid), bismuth (standard dose, qid), tetracycline (500 mg, qid), and metronidazole (250 mg, qid) for 10–14 days

Second-line therapy

Levofloxacin-based triple therapy

PPI (standard dose, bid), levofloxacin (500 mg, qd), and amoxicillin (1 g, bid) for 10 days

Bismuth-containing quadruple therapy

PPI (standard dose, bid), bismuth (standard dose, qid), tetracycline (500 mg, qid), and metronidazole (500 mg, tid) for 10–14 days

Sequential therapy

Sequential therapy

5-day dual therapy with a PPI (standard dose, bid) and amoxicillin (1 g, bid) followed by a 5-day triple therapy with a PPI (standard dose, bid), clarithromycin (500 mg, bid), and metronidazole (500 mg, bid)

Third-line therapy

Culture-guided therapy

10-day quadruple therapy comprising a PPI (standard dose, bid), bismuth (standard dose, qid), and two antibiotics selected by antimicrobial sensitivity tests

Levofloxacin-based

PPI (standard dose, bid), bismuth (standard dose, qid), levofloxacin (500 mg, qd), and amoxicillin (500 mg, qid) for 10 days

Test it again.

Repeat testing after H. pylori eradication therapy—the "test-treat-retest" strategy—should be offered to all patients to confirm that the infection has been cured. The following reasons are offered:

  • Confirmatory testing is good medicine
  • Intention-to-treat analysis of US randomized trials show that successful eradication was achieved in only about three-fourths of patients receiving optimal treatment regimens for H. pylori eradication
  • Patients often fail to adhere to their full eradication drug regimen
  • Antibiotic resistance is rising among H. pylori organisms. H. pylori resistance to clarithromycin is well documented, and it can reach levels of up to 25% depending on the population
  • Many patients want to know if their infection has been cured
  • Results of the stool antigen test HpSA® aid in the definitive diagnosis of active H. pylori infection, can be used to monitor response during and after treatment, and can confirm eradication of H. pylori.
  • Confirmation of eradication should be performed 1 month after eradication therapy has been completed.

Reference: 1. Urgesi, R, Ciaci R, Ricconi ME. Update on triple therapy for eradication of Helicobacter pylori: current status of the art. Clin Exp Gastroenterol. 2012;5:151-157.