H Pylori Treatment

When H. pylori infection is not treated on time, the patient can develop serious complications that can endanger his/her life. Fortunately, H. pylori can be treated with different regimens of oral antibiotics, so in the first instance, no invasive treatments are needed.

The specific antibiotic treatment must be selected for each patient according to the bacterial resistance patterns in his/her geographical area, the availability of antibiotic, other risk factors for complications, the severity of infection, among others.

To avoid the development of bacterial resistance to antibiotics, only the patients with positive tests for H. pylori infection must be treated and it is very important to understand that the treatment must be completed as the doctor indicates to avoid the recurrence of infection.

The FDA (Food and Drug Administration) has established different treatment guidelines that can be adapted and used in different countries around the world. These treatment guidelines are called “triple therapies” due to the combination of different drugs to eradicate the H. pylori infection. Triple therapies usually have cure rates between 85 and 90%; however, the antimicrobial resistance rate is growing, so new treatment guidelines have been developed and called “quadruple therapies”.

One of the pillars of triple treatment are the drugs that suppress the stomach acid secretion, like proton pump inhibitors (PPIs), histamine (H-2) blockers, and bismuth sub salicylate. All of them have a different mechanism of action, but the final effect is the same. When these drugs decrease the stomach acid secretion, the pH gets higher (alkaline), which weakens the H. pylori.

The most common drugs combinations in triple therapies schemes are:

– A PPI (like omeprazole, lansoprazole, esomeprazole, or pantoprazole), clarithromycin, and metronidazole. This therapy scheme is recommended for endemic areas with low bacterial resistance to clarithromycin.

In geographic areas with high rates of bacterial resistance to clarithromycin, it must be replaced by amoxicillin. This scheme of treatment is indicated to be used for a period of time between 10 and 14 days.

– As an alternative, bismuth sub salicylate can be used, associated to metronidazole, and tetracycline. This scheme of treatment is indicated for 14 days. Likewise, lansoprazole, amoxicillin, and clarithromycin can also be used as the second line in geographic areas with low bacterial resistance to clarithromycin for 10 to 14 days.

On the other hand, the most common quadruple therapy to eradicate H. pylori includes a PPI, bismuth sub-salicylate, tetracycline, and metronidazole during 10 or 14 days.

After undergoing either triple or quadruple therapy, the doctor can indicate a new test to detect H. pylori four weeks after the end of treatment to check if the infection was successfully overcome. If the treatment was unsuccessful and the patient still has H. pylori in his/her body, he/she may need a second cycle of treatment with a different combination of drugs that suppress the stomach acid secretion, and more antibiotics.

Surgery is not a treatment to eradicate H. pylori infection; however, when the ulcer becomes complicated with a complete perforation or stomach cancer, surgical procedures are needed.