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.
Suggested Regimens for the Treatment of Helicobacter pylori Infection9
Howden C, Hunt R. Guidelines for the management of Helicobacter pylori infection. Am J Gastroenterol 1998;83:2330-2338.
(The regimens below are more current than the FDA-approved treatment options)
PPI (lansoprazole 30 mg OR omeprazole 20 mg) + amoxicillin 1000 mg + clarithromycin 500 mg (each drug given twice daily for two weeks)
PPI (lansoprazole 30 mg OR omeprazole 20 mg) + metronidazole 500 mg + clarithromycin 500 mg (each drug given twice daily for two weeks)
Ranitidine bismuth citrate (RBC) 400 mg + clarithromycin 500 mg + amoxicillin 1000 mg OR metronidazole 500 mg OR tetracycline 500 mg (each drug given twice daily for 2 wk)
Bismuth subsalicylate 525 mg four times daily + metronidazole 500 mg three times daily + tetracycline 500 mg four times daily + PPI (lansoprazole 30 mg once daily OR omeprazole 20 mg once daily) (each drug given in the dosage and frequency indicated daily for two weeks)
Bismuth subsalicylate 525 mg four times daily + metronidazole 250 mg four times daily + tetracycline 500 mg four times daily + H2-receptor antagonist (each drug given in the dosage and frequency indicated daily for two weeks with the H2-receptor antagonist continued for a further two weeks)
Confirm Eradication
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 U.S. 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
Many patients want to know if their infection has been cured |
