{"id":2177,"date":"2018-11-08T19:49:05","date_gmt":"2018-11-08T19:49:05","guid":{"rendered":"https:\/\/medicalcriteria.com\/web\/?p=1361"},"modified":"2026-02-09T19:27:19","modified_gmt":"2026-02-09T19:27:19","slug":"helicobacter-pylori","status":"publish","type":"post","link":"https:\/\/medicalcriteria.com\/web\/helicobacter-pylori\/","title":{"rendered":"Helicobacter pylori Infection in Peptic Ulcer Disease"},"content":{"rendered":"<div class=\"99c380e4b4a7b96c35d7ddf7dcb434e8\" data-index=\"1\" style=\"float: none; margin:0px 0 0px 0; text-align:center;\">\n<script async src=\"https:\/\/pagead2.googlesyndication.com\/pagead\/js\/adsbygoogle.js\"><\/script>\r\n<!-- MC 2019- Horizontal -->\r\n<ins class=\"adsbygoogle\"\r\n     style=\"display:block\"\r\n     data-ad-client=\"ca-pub-0127150553352455\"\r\n     data-ad-slot=\"3806776041\"\r\n     data-ad-format=\"auto\"\r\n     data-full-width-responsive=\"true\"><\/ins>\r\n<script>\r\n     (adsbygoogle = window.adsbygoogle || []).push({});\r\n<\/script>\n<\/div>\n<p>Endoscopy is the gold standard for diagnosis of peptic\u00a0ulcer disease. Apart from\u00a0 exclusion of malignant disease,\u00a0detection of H pylori infection with histology or rapid\u00a0urease tests is essential to the subsequent treatment\u00a0plan.\u00a0<!--more--><\/p>\n<p>The standard\u00a0first-line therapies used to be regimens, consisting of a\u00a0proton-pump inhibitor (PPI) and two antibiotics, such as\u00a0clarithromycin plus amoxicillin or metronidazole given\u00a0for 7\u221214 days (termed PPI-based triple therapy).<\/p>\n<p>Most frequent regimens recommended for treatment of Helicobacter pylori infection in peptic\u00a0ulcer disease<\/p>\n<table style=\"border-collapse: collapse; width: 100%;\" border=\"1\">\n<tbody>\n<tr>\n<td style=\"width: 15.7534%;\"><\/td>\n<td style=\"width: 20.3768%;\">Drug combinations<\/td>\n<td style=\"width: 52.0547%;\">Regimen<\/td>\n<td style=\"width: 11.8151%;\">Duration<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 15.7534%;\">Triple therapy<\/td>\n<td style=\"width: 20.3768%;\">PPI plus amoxicillin* plus<br \/>\nclarithromycin<\/td>\n<td style=\"width: 52.0547%;\">Double dose\u2020 of PPI every 12 h<br \/>\n1000 mg amoxicillin every 12 h<br \/>\n500 mg clarithromycin every 12 h<\/td>\n<td style=\"width: 11.8151%;\">14 days<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 15.7534%;\">Quadruple<br \/>\nnon-bismuth-based<br \/>\nconcomitant therapy<\/td>\n<td style=\"width: 20.3768%;\">PPI plus amoxicillin plus<br \/>\nclarithromycin plus<br \/>\nmetronidazole<\/td>\n<td style=\"width: 52.0547%;\">Standard dose of PPI every 12 h<br \/>\n1000 mg amoxicillin every 12 h<br \/>\n500 mg clarithromycin every 12 h<br \/>\n500 mg metronidazole every 12 h<\/td>\n<td style=\"width: 11.8151%;\">14 days<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 15.7534%;\">Bismuth-based<br \/>\nquadruple therapy<\/td>\n<td style=\"width: 20.3768%;\">PPI plus bismuth<br \/>\nsubcitrate plus tetracycline<br \/>\nplus metronidazole<\/td>\n<td style=\"width: 52.0547%;\">Standard dose of PPI every 12 h<br \/>\n120 mg bismuth subcitrate every<br \/>\n6 h<br \/>\n500 mg tetracycline every 6 h<br \/>\n500 mg metronidazole every 8 h<\/td>\n<td style=\"width: 11.8151%;\">14 days<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 15.7534%;\">Fluoroquinolone-based<br \/>\ntriple therapy\u2021<\/td>\n<td style=\"width: 20.3768%;\">PPI plus amoxicillin plus<br \/>\nlevofloxacin with or<br \/>\nwithout bismuth<\/td>\n<td style=\"width: 52.0547%;\">Standard dose of PPI every 12 h<br \/>\n1000 mg amoxicillin every 12 h<br \/>\n500 mg levofloxacin every 24 h<br \/>\n240 mg bismuth every 12 h<\/td>\n<td style=\"width: 11.8151%;\">14 days<\/td>\n<\/tr>\n<tr>\n<td style=\"width: 15.7534%;\">Rifabutin-based triple<br \/>\ntherapy\u00a7<\/td>\n<td style=\"width: 20.3768%;\">PPI plus amoxicillin plus<br \/>\nrifabutin<\/td>\n<td style=\"width: 52.0547%;\">Standard dose of PPI every 12 h<br \/>\n1000 mg amoxicillin every 12 h<br \/>\n150 mg rifabutin every 12 h<\/td>\n<td style=\"width: 11.8151%;\">10 days<\/td>\n<\/tr>\n<\/tbody>\n<\/table>\n<p>Other regimens used in the treatment of Helicobacter pylori combine different antibiotics with similar results\u00a0(eg, triple therapy could combine a proton pump inhibitor [PPI] plus amoxicillin plus metronidazole or PPI plus\u00a0metronidazole plus clarithromycin). Sequential quadruple therapy consists of a 5-day dual therapy with a PPI and\u00a0amoxicillin followed by a 5-day triple therapy with a PPI plus clarithromycin plus tinidazole or metronidazole.<br \/>\nHybrid quadruple therapies combine 10\u201314 days of dual therapy with PPI and amoxicillin with 7 days of treatment\u00a0with clarithromycin and metronidazole at the end (or start, for reverse therapy).<br \/>\n*Use metronidazole if patients have\u00a0penicillin allergy. \u2020Double doses: omeprazole 40 mg, lansoprazole 60 mg, rabeprazole 40 mg, esomeprazole 40 mg.<br \/>\n\u2021Used as rescue regimen; bismuth-based therapy can be added to these drugs (for fluoroquinolone-based quadruple\u00a0therapy).<br \/>\n\u00a7To be used when at least three recommended options have failed and if H pylori susceptibility testing is not\u00a0available.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References:<\/strong><\/p>\n<ol>\n<li>Sun M, Liu E, Yang L, Cao H, Han M. A scoping review of worldwide guidelines for diagnosis and treatment of Helicobacter pylori infection. Syst Rev. 2025 May 9;14(1):107. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/40346683\/\" target=\"_blank\" rel=\"noopener\">[Medline]<\/a><\/li>\n<li>Lanas A, Chan FKL. Peptic ulcer disease.\u00a0Lancet. 2017 Aug 5;390(10094):613-624. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/28242110\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Kempenich JW, Sirinek KR. Acid Peptic Disease.\u00a0Surg Clin North Am. 2018 Oct;98(5):933-944.\u00a0<a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/30243454\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<li>Fallone CA, Chiba N, van Zanten SV, Fischbach L, Gisbert JP, Hunt RH, Jones NL, Render C, Leontiadis GI, Moayyedi P, Marshall JK. The Toronto Consensus for the Treatment of Helicobacter pylori Infection in Adults.\u00a0Gastroenterology. 2016 Jul;151(1):51-69. <a href=\"https:\/\/pubmed.ncbi.nlm.nih.gov\/27102658\/\" target=\"_blank\" rel=\"noopener noreferrer\">[Medline]<\/a><\/li>\n<\/ol>\n<p>&nbsp;<\/p>\n<p>Created Nov 05, 2018.<br \/>\nIp-date Feb 9, 2026.<\/p>\n\n<div style=\"font-size: 0px; height: 0px; line-height: 0px; margin: 0; padding: 0; clear: both;\"><\/div>","protected":false},"excerpt":{"rendered":"<p>Sorry, this entry is only available in Espa\u00f1ol.<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"closed","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_lmt_disableupdate":"no","_lmt_disable":"no","_exactmetrics_skip_tracking":false,"_exactmetrics_sitenote_active":false,"_exactmetrics_sitenote_note":"","_exactmetrics_sitenote_category":0,"footnotes":""},"categories":[53],"tags":[51,270,333,266,267,369,365,366,271,368,367],"class_list":["post-2177","post","type-post","status-publish","format-standard","hentry","category-gastroenterology","tag-disease","tag-helicobacter","tag-ibp","tag-infeccion","tag-infection","tag-peptic","tag-peptica","tag-ppi","tag-pylori","tag-ulcer","tag-ulcera"],"modified_by":"Guillermo Firman","_links":{"self":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2177","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/comments?post=2177"}],"version-history":[{"count":4,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2177\/revisions"}],"predecessor-version":[{"id":10644,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/posts\/2177\/revisions\/10644"}],"wp:attachment":[{"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/media?parent=2177"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/categories?post=2177"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/medicalcriteria.com\/web\/wp-json\/wp\/v2\/tags?post=2177"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}