Treatment Options for PUD
Although several treatment regimens for H. pylori infection have been identified,
none has yet emerged as superior. Variables such as cost, tolerability, ease of
administration, and patient compliance should be considered when prescribing therapy.
Suggested Regimens for the Primary Treatment of Helicobacter pylori Infection1
In the United States, the recommended primary therapies for H. pylori infection
- a proton pump inhibitor (PPI), clarithromycin, and amoxicillin, or metronidazole
(clarithromycin-based triple therapy) for 14 days, or
- a PPI or H2RA, bismuth, metronidazole, and tetracycline (bismuth quadruple therapy)
for 10–14 days.
This course of therapy has met with the greatest success in eradicating H. pylori
Sequential therapy consisting of a PPI and amoxicillin for 5 days followed by a
PPI, clarithromycin, and tinidazole for an additional 5 days may provide an alternative
to clarithromycin-based triple or bismuth quadruple therapy but requires validation
within the United States before it can be recommended as a first-line therapy.
The first course of therapy above has met with the greatest success in eradicating
H. pylori infection.
Test-treat-retest-and confirm eradication strategy
According to recommendations by AGA, AGC, and ACCF, repeat testing after H. pylori
eradication therapy – the “test-treat-retest” strategy – should be offered to all
patients to confirm that the infection has been cured. Intent-to-treat analysis
of U.S. randomized trials show that 25% of patients receiving treatment regiments
for H. pylori eradication will fail, therefore it is recommended that retesting
is performed on each patient who tests positive for H. pylori infection.
The American College of Gastroenterology recommends testing to prove eradication.
Testing should be performed no sooner than 4 weeks after the end of treatment in
- Any patient with H. pylori-associated ulcer
- Patients with persistent dyspeptic symptoms
- Patients with H. pylori-associated MALT lymphoma
- Patients who have undergone resection of early gastric cancer
Download a Test-and-treat algorithm
Find links to the most recent professional guidelines