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Principles of Eradication Therapy for Helicobacter pylori infection

  1. Indications for diagnosis and treatment, established (Chey and Wong):
    1. Active peptic ulcer disease.
    2. Confirmed history of peptic ulcer disease not previously treated for H. pylori.
    3. Gastric MALT lymphoma.
    4. After endoscopic resection of early gastric cancer.
    5. Uninvestigated dyspepsia (review H. pylori prevalence).
  2. Low resistance areas:
    1. In areas of low clarithromycin resistance the PPI-clarithromycin-containing triple therapy is recommended as the first-line treatment as well as bismuth-containing quadruple therapy (maastrich).
    2. In areas of low clarithromycin resistance after failure of a PPI-clarithromycin-containing treatment, either a bismuth-containing quadruple therapy or levofloxacin-containing triple therapy is recommended.
  1. High resistance areas:
  1. In areas of high clarithromycin resistance, bismuth-containing quadruple therapies are recommended for first-line treatment.
  1. In areas of high clarithromycin resistance after failure of bismuth containing quadruple therapy, levofloxacin containing triple therapy is recommended.
  1. After failure of second-line treatment, treatment should be guided by antimicrobial susceptibility testing whenever possible. (maastrich)
  2. FDA PPI standard doses
    1. Lansoprazole 30 mg q12h
    2. Omeprazole 20 mg q12h
    3. Esomeprazole 40 mg q24h.
    4. Rabeprazole 20 mg q12h
  3. FDA approved first line regimens duration:
    1. Triple therapy: 7 days (10 days if rabeprazole).
    2. Quadruple therapy: 4 weeks.
  4. Confirm the eradication of H. pylori infection in patients who have had an H. pylori–associated ulcer or gastric MALT lymphoma or who have undergone resection for early gastric cancer.
  5. The urea breathing test is the most reliable nonendoscopic test to document eradication of H. pylori infection.
  6. Testing to prove H. pylori eradication is most accurate if performed at 4 wk after the completion of eradication therapy.

Helicobacter pylori Eradication Therapies

▸ Click on the following categories to expand treatment regimens.[1][2][3][4][5][6]

First line

  ▸  Triple therapy

  ▸  Quadruple therapy

Second line

  ▸  Triple therapy

  ▸  Sequential therapy

  ▸  Hybrid therapy

Third line therapy (Rescue therapy)

  ▸  Rifabutin based

Triple therapy
PPI standard dose
PLUS
Clarithromycin 500 mg q12h.
PLUS
Amoxicillin 1,0000 mg q12h
Quadruple therapy
Bismuth subsalicylate 525 mg orally q6h
PLUS
Metronidazol 250 mg orally q6h
PLUS
Tetracycline 500 mg orally q6h
PLUS
Ranitidine 150 mg orally q12h
OR
PPI standard dose
Triple therapy
PPI standard dose
PLUS
Clarithromycin 500 mg q12h
PLUS
Metronidazole 500 mg q12h
Sequential therapy
First 5 days
PPI standard dose
PLUS
Amoxicillin 1,000 mg q12h
Next 5 days
PPI standard dose
PLUS
Clarithromycin 500 mg q12h
PLUS
Tinidazol 500 mg q12h
Sequential therapy
First 7 days
PPI standard dose
PLUS
Amoxicillin 1,000 mg q12h
Next 7 days
PPI standard dose
PLUS
Amoxicillin 1,000 mg q12h
PLUS
Clarithromycin 500 mg q12h
PLUS
Metronidazol 500 mg q12h
Third line treatment
Rifabutin 150 mg q2h
PLUS
Amoxicillin 1,000 mg IV q12h
PLUS
Ciprofloxacin 500 mg/kg IV q12h

References

  1. Chey WD, Wong BC, Practice Parameters Committee of the American College of Gastroenterology (2007). "American College of Gastroenterology guideline on the management of Helicobacter pylori infection". Am J Gastroenterol. 102 (8): 1808–25. doi:10.1111/j.1572-0241.2007.01393.x. PMID 17608775.
  2. Garza-González E, Perez-Perez GI, Maldonado-Garza HJ, Bosques-Padilla FJ (2014). "A review of Helicobacter pylori diagnosis, treatment, and methods to detect eradication". World J Gastroenterol. 20 (6): 1438–49. doi:10.3748/wjg.v20.i6.1438. PMC 3925853. PMID 24587620.
  3. O'Connor A, Molina-Infante J, Gisbert JP, O'Morain C (2013). "Treatment of Helicobacter pylori infection 2013". Helicobacter. 18 Suppl 1: 58–65. doi:10.1111/hel.12075. PMID 24011247.
  4. McColl KE (2010). "Clinical practice. Helicobacter pylori infection". N Engl J Med. 362 (17): 1597–604. doi:10.1056/NEJMcp1001110. PMID 20427808.
  5. Song M, Ang TL (2014). "Second and third line treatment options for Helicobacter pylori eradication". World J Gastroenterol. 20 (6): 1517–28. doi:10.3748/wjg.v20.i6.1517. PMC 3925860. PMID 24587627.
  6. Majumdar, Debabrata; Bebb, James; Atherton, John (2007). "Helicobacter pylori infection and peptic ulcers". Medicine. 35 (4): 204–209. doi:10.1016/j.mpmed.2007.01.006. ISSN 1357-3039.