Treatments

Treatment for H. pylori focuses on eradicating the bacteria from the stomach using a
combination of organism-specific antibiotics combined with an acid suppressor and/or
stomach protector. The use of only one or two medications to treat H. pylori is not
recommended as H.pylori is able to develop resistance.  Due to resistance patterns and
medication availability, different countries have different approved treatments for H. pylori.

FIRST LINE TREATMENTS:

Following confirmation in the 1980s that H.pylori caused peptic ulcers, the Centre for
Digestive Diseases Medical Director and Founder, Professor Thomas Borody, developed
the first therapy to fight H.pylori and cure peptic ulcers.  This went on to become the gold
standard treatment globally.
At this time, a proven and effective treatment in Australia is a 7-day course of medication
called Triple Therapy.  Triple therapy uses two antibiotics, amoxicillin and clarithromycin, to
kill the bacteria combined with an acid suppressor to enhance the antibiotic activity whilst
protecting the stomach.   This regimen of triple therapy reduces symptoms, kills H. pylori
and prevents ulcer recurrence in around 65% of patients but due to the emergence of
antibiotic resistant strains of H.pylori the efficacy of this regime is slowly falling.
If standard first line treatment fails to eradicate the H. pylori infection, the same antibiotic
combination should not be repeated as the remaining bacteria develop resistance.

SECOND LINE (SALVAGE or RESCUE) TREATMENT:

We, at the Centre for Digestive Diseases) are especially interested in treatment
alternatives, effective for patients who have failed other standard therapies.  These
‘salvage’ or ‘rescue’ therapies comprise varying combinations of three or more anti-H.pylori
drugs.
At the Centre for Digestive Diseases, following a treatment failure and at times for initial
therapy, a combination regime is prescribed on a patient-by-patient basis.  Our second-line
treatments take into consideration the number and type of previous treatments the patient
has been exposed to, their past medical history, tolerance to medications, lifestyle, diet
habits and intensity of the H. pylori infection.  When necessary we team this knowledge
with results from the antibiotic sensitivity profile of the infecting bacteria to create the
individualised protocol.
When tailored, second line treatments prescribed for H. pylori, achieve successful
eradication in virtually all patients.  At the Centre for Digestive Diseases (CDD) one of our
second-line treatment has a success rate of greater than 96% (published data), compared
to re-treating with the same or similar first-line treatments which have a low success rate.
Treatment components which may be used may include amoxicillin, proton pump
inhibitors, furazolidone, bismuth, nitazoxanide, levofloxacin and lactoferrin. Furthermore,
the immunity of the gastric lining may need to be ‘stimulated’- one of the current research
projects in which it has been shown that some patients have an immune deficiency which
contributes to eradication failure.