Treatment of Helicobacter pylori infection

Medicine pills. Background made from many colorful pillsHelicobacter pylori bacterium (formerly known as Campylobacter pylori or pyloridis) is a gram-negative bacterium that is usually found in the stomach and duodenum and is associated with gastritis and peptic ulcers. H. pylori attach to the mucus cells of the stomach and cause the inflammation of the stomach lining. H. pylori infection spreads via oral-to-oral, fecal-to-oral contact, contaminated food or water. Treatment of Helicobacter pylori infection is necessary for the treatment of type B gastritis, which is considered to be caused by the infection. The significance of H.pylori eradication is determined by the fact that H.pylori infection may lead to the development of gastritis, peptic ulcer and, finally, cancer.

Principles of eradication therapy

1) Combination therapy should be used as monotherapy is not effective enough;

2) Only recommended regimens have to be prescribed;

3) Therapy adherence determines treatment effectiveness and helps t avoid antibiotic resistance:

4) To confirm the treatment effectiveness the person should be shown to be free from helicobacter at least 1 month after the therapy was ended.  

Several different regimens may be used to eradicate Helicobacter pylori infection.

Triple therapy

Triple therapy is an option for first-line therapy in areas of low clarithromycin resistance and consists of the following:

  1. Proton pump inhibitor (PPI) (omeprazole 20 mg twice a day (BID), lansoprazole 30 mg BID, esomeprazole 40 mg four times per day (QD), etc.) plus
  2. Clarithromycin 500 mg BID or metronidazole 500 mg BID (in case of clarithromycin resistance) plus
  3. Amoxicillin 1000 mg BIDor metronidazole for 7-14 days;

For those who are allergic to penicillin, amoxicillin may be substituted with metronidazole.

Non bismuth quadruple therapy

Non bismuth quadruple therapy may be given sequentially or concomitantly.

1) Sequential therapy

Sequential therapy requires a 14-day intake of medications and consists of the following:

  1. PPI plus amoxicillin for 5-7 days (pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days), then
  2. PPI plus 2 other antibiotics (usually clarythromycin and metronidazole) for the next 5-7 days;

2)Concomitant therapy

Concomitant therapy consists of the following:

  • PPI plus
  • Amoxicillin plus
  • Clarithromycin (1 g QD)plus
  • Metronidazole;

Duration of concomitant therapy is 10-14 days. 

Bismuth-based therapy

Bismuth-based therapy is an alternative first-line therapy (in areas with high clarithromycin and metronidazole resistance) or second-line therapy.  It lasts for 10-14 days and consists of:

  1. PPI or H2 receptor antagonist (lansoprazole 30 mg BID or ranitidine 150 mg BID) plus
  2. Bismuth subsalicylate 525 mg QID (or bismuth tripotassium dicitrate 300 mg QID) plus
  3. Metronidazole 250 mg QID or 500 mg TID(or levofloxacin) plus
  4. Tetracycline 500 mg QID

Levofloxacin-containing therapy

This is an alternative first-line regimen and consists of a PPI plus amoxicillin 1 g BID plus levofloxacin 500 mg QD for 7-10 days.

Second-line therapy should not include the previously used first-line and should include at least one different antibiotic.

DISCLAIMER: Self-treatment is strongly not recommended. Consult with your physician regarding your condition in order to verify the diagnosis and choose the appropriate regimen.