Medical Health Encyclopedia

The standard treatment regimen for H. pylori uses two or three antibiotics and a proton-pump inhibitor. Cure rates after antibiotic treatment range from 70 - 90%. A typical regimen contains three drugs:

• A proton-pump inhibitor. These drugs include omeprazole (Prilosec), lansoprazole (Prevacid), esomeprazole (Nexium), and rabeprazole (Aciphex). Proton-pump inhibitors are important for all types of peptic ulcers and a critical partner of antibiotic regimens. They reduce the acidity in the intestinal tract, and increase the ability of antibiotics to destroy H. pylori.
• Two antibiotics. Standard antibiotics are clarithromycin (Biaxin) and amoxicillin. (Some doctors substitute the antibiotic metronidazole (Flagyl) for clarithromycin or amoxicillin.)

This combination treatment is typically taken for at least 14 days. Many studies, however, suggest that a 7-day treatment may work just as well.

Follow-Up. Follow-up testing for the bacteria should be done no sooner than four weeks after therapy is completed. Test results before that time may not be accurate.

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In most cases, drug treatment relieves symptoms of ulcers. However, symptom relief after treatment does not always indicate success, nor does persistence of dyspepsia necessarily mean that treatment has failed. Heartburn and other symptoms from gastroesophageal reflux disease (GERD), for example, sometimes worsen and require acid-suppression agents.

Failure. Treatment fails in about 15% of cases. Most often this is because patients fail to adhere to the regimen. Compliance with standard antibiotic regimens have been poor for the following reasons:

• The triple-drug regimens are complicated and require many pills. Helicide or two-drug combinations may help offset this problem.
• Side effects from the H. pylori regimens occur in up to 30% of patients. Gastrointestinal problems are very common, and cases of severe diarrhea have occurred during treatment.