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 include:

• 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 infection.

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 these patients:

• 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