TOC | GI
Dyspepsia REF: h_pylori 2010.pdf
Uncomplicated Dyspepsia (with or without history of ulcer):
Treatment of H.pylori See also Helicobacter Foundation Site
The Standard regimen: 3-drug regimen given for ONE WEEK is recommended as first-line therapy for eradication of H.pylori in patients who test positive:
Sequential regimen: (REF:
Ann Intern Med Jan 17, 2006;144:94-100 De Francesco V,
(REF: Meta-analysis: Sequential Therapy Appears Superior to Standard Therapy for Helicobacter pylori Infection in Patients Naive to Treatment. Nadim S. Jafri, MD, MSc; Carlton A. Hornung, PhD, MPH; and Colin W. Howden, MD 17 June 2008 | Volume 148 Issue 12)
The Sequential regimen was more effective than standard regimen in eradicating both susceptible & resistant H.pylori strains.
Antimicrobial agents with activity against H. pylori include metronidazole,
tetracycline, amoxicillin, clarithromycin, and fluoroquinolones such as
Most popular in the United States are 10- to 14-day combination regimens, although 7-day courses may be almost as effective and are more popular in Europe.
A 2-week course of a three-drug regimen that includes a proton pump inhibitor, clarithromycin, and amoxicillin has a success rate approaching 90%.
One recent study from Italy demonstrated close to 90% efficacy with a 7-day levofloxacin-based triple therapy; the efficacy rate exceeded those of standard (amoxicillin-based or metronidazole-based) 7-day triple therapies by 10% to 15%, suggesting that this regimen can be an alternative to standard 10-day and 14-day regimens for first-line therapy.
[Nista EC, Candelli M, Zocco MA, et al: Levofloxacin-based triple therapy in first-line treatment for Helicobacter pylori eradication. Am J Gastroenterol 101:1985, 2006]
JCOM Feb 2002 "Abbreviated Regimens for H. pylori Eradication in PUD"
Treatment of Dyspeptic Symptoms
§ Lifestyle Modification
§ If symptoms persist after lifestyle modification and/or H. Pylori treatment, treat with:
* Treatment with high-dose H2 antagonists should not continue for longer than 8 weeks.
If symptoms persist after 8 weeks, then reevaluation of the patient's medical history is necessary.
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