The management of
Helicobacter pylori infection involves several treatment regimens, which can be broadly categorized into triple, quadruple, sequential, and hybrid therapies. The choice of regimen is influenced by factors such as local antibiotic resistance patterns, patient's previous exposure to antibiotics, and potential side effects.
Triple therapies
- Standard triple therapy: This regimen typically includes a proton pump inhibitor (PPI), amoxicillin, and clarithromycin for 14 days; however, its efficacy has been questioned due to increasing clarithromycin resistance worldwide
- Levofloxacin triple therapy: Comprising a PPI, levofloxacin, and amoxicillin for 10–14 days, this regimen is recommended by the ACG 2017 guidelines as a first-line therapy option ; it has also been found to achieve high eradication rates in Western countries
Quadruple therapies
- Bismuth quadruple therapy: This regimen includes a PPI, bismuth, tetracycline, and metronidazole or tinidazole for 10–14 days. It is recommended as a first-line therapy by several guidelines, particularly in patients with any previous macrolide exposure or in patients with penicillin allergy
- Non-bismuth quadruple therapy (concomitant therapy): This involves a PPI, clarithromycin, amoxicillin, and metronidazole or tinidazole taken simultaneously for 10–14 days; it is an alternative to quadruple therapy and may be used in regions with high antibiotic resistance
Sequential and hybrid therapies
- Sequential therapy: This regimen starts with a PPI and amoxicillin for the first 5–7 days, followed by a PPI, clarithromycin, and a nitroimidazole for the next 5–7 days; the total duration is typically 10–14 days
- Hybrid therapy: This involves a PPI and amoxicillin for 7 days, followed by a PPI, amoxicillin, clarithromycin, and a nitroimidazole for 7 days; it has been found to achieve high eradication rates
Other therapies
- Vonoprazan triple therapy: This novel regimen, which includes vonoprazan, a potassium-competitive acid blocker, has been found to achieve high eradication rates of over 90%
The choice of regimen for
H. pylori infection should be individualized, taking into account local resistance patterns, patient's previous antibiotic exposure, and potential side effects.