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Treatment regimens for Helicobacter pylori

Section Editor
Mark Feldman, MD, MACP, AGAF, FACG
Deputy Editor
Shilpa Grover, MD, MPH, AGAF


Multiple regimens have been evaluated for Helicobacter pylori therapy in randomized controlled trials [1-5]. Despite the number of studies, the optimal therapeutic regimen has not yet been defined. The treatment regimen that is selected must be effective, but considerations such as cost, side effects, and ease of administration should also be taken into account. (See "Indications and diagnostic tests for Helicobacter pylori infection", section on 'Indications for testing'.)

This topic review will discuss treatment regimens for H. pylori. The indications and diagnostic tests for H. pylori infection, as well as the bacteriology and epidemiology, are discussed elsewhere. (See "Indications and diagnostic tests for Helicobacter pylori infection" and "Bacteriology and epidemiology of Helicobacter pylori infection".)


Triple therapy with a proton pump inhibitor (PPI) should be used in areas where clarithromycin resistance is low (<15 percent) or eradication rates are high (>85 percent). However, in patients with recent (<3 months) or repeated exposure to clarithromycin or metronidazole and in patients who fail triple therapy, bismuth quadruple therapy should be used to treat H. pylori [6-12].

For patients in areas where clarithromycin resistance is high (≥15 percent) and who do not have recent or repeated exposure to clarithromycin or metronidazole, bismuth-containing or concomitant non-bismuth containing quadruple therapy should be used as first-line therapy [13]. In the United States, given the limited information on antimicrobial resistance rates, we generally assume clarithromycin resistance rates are greater than 15 percent unless local data indicate otherwise [14].  

Triple therapy — The regimen most commonly recommended for first line treatment of H. pylori is triple therapy with a PPI (lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 20 mg twice daily or esomeprazole 40 mg once daily), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for 7 to 14 days. We suggest treatment for 14 days [13].


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Literature review current through: Mar 2017. | This topic last updated: Dec 01, 2016.
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