TOC   |  GI   

Dyspepsia                              REF:  h_pylori 2010.pdf

Acid-Peptic Disease  

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:

  1. Pantoprazole (Protonix) 40 mg BID (#14 x 40mg), plus
  2. Clarithromycin (Biaxin) 500 mg BID (#14 x 500mg), plus
  3. Amoxicillin 1 gram BID (#28 x 500mg)  or may use Metronidazole/Flagyl 500 mg BID if amoxicillin is not tolerated.  

Sequential regimen:   (REF:  Ann Intern Med Jan 17, 2006;144:94-100 De Francesco V, etc.)
(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.

  1. Proton-pump inhibitor (as Rabeprazole) + Amoxicillin 1 gam BID  x 5 days, then
  2. Proton-pump inhibitor (as Rabeprazole) + Clarithromycin /Biaxin + Tinidazole (or metronidazole/Flagyl)  for the next 5 days

Antimicrobial agents with activity against H. pylori include metronidazole, tetracycline, amoxicillin, clarithromycin, and fluoroquinolones such as levofloxacin.
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.

Back-to-top  |  Home Page