HELICOBACTER PYLORI INFECTION

Helicobacter pylori (H. pylori) infection is a major element in the pathogenesis of

dyspepsia, gastritis, gastroduodenal ulcer disease, gastric carcinoma and gastric lymphoma.

Methods of Detection

Non-invasive methods Invasive methods

C-urea breathing test Histology
Stool antigen test Culture
Serologic Antibody Tests Rapid urea test

Treatment of H. pylori infection

General considerations

1. For initial treatment, a two-week triple-therapy regimen that comprises a proton

pump inhibitor (PPI), Clarithromycin and either amoxicillin or metronidazole is
used. PPI should be continued for at least 4 weeks after cessation of triple therapy.
2. If a patient has been treated with metronidazole for other infections, a regimen
containing a proton pump inhibitor, amoxicillin and Clarithromycin is preferred for
initial therapy.
3. If a patient has been treated with a macrolide for other infections, a regimen
containing a proton pump inhibitor, amoxicillin and metronidazole is preferred for
initial therapy.
4. Treatment failure usually indicates antibacterial resistance or poor compliance.
5. Resistance to amoxicillin is rare; however, resistance to clarithromycin and
metronidazole is common and can develop during treatment.
6. Two-week triple-therapy regimens offer the possibility of higher eradication rates
compared to one-week regimens, but adverse effects are common and poor
compliance is likely to offset any possible gain.
7. Garlic inhibits the growth of H. pylori. It can be used as an adjunct to the triple
therapy.
 Recommended regimens for Helicobacter pylori eradication in adults
Acid suppressant Antibacterial
Amoxicillin Clarithromycin Metronidazole
Esomeprazole 20 mg 1 g twice daily 500 mg twice daily —
twice daily — 250 mg twice daily 400 mg twice daily
Lansoprazole 30 mg 1 g twice daily 500 mg twice daily —
twice daily 1 g twice daily — 400 mg twice daily
— 250 mg twice daily 400 mg twice daily
Omeprazole 20 mg 1 g twice daily 500 mg twice daily —
twice daily 500 mg 3 times a day — 400 mg 3 times a day
— 250 mg twice daily 400 mg twice daily
Pantoprazole 40 mg 1 g twice daily 500 mg twice daily —
twice daily — 250 mg twice daily 400 mg twice daily
Rabeprazole sodium 1 g twice daily 500 mg twice daily —
20 mg twice daily — 250 mg twice daily 400 mg twice daily

PREPARED BY;

MIYINGO IVAN
BPHARM, MPS

©2020