How is Helicobacter pylori treated?
Infection with H. pylori is usually treated with a combination of three drugs (triple therapy). A proton pump inhibitor such as esomeprazole (Nexium), lansoprazole (Prevacid), omeprazole (Prilosec), pantoprazole (Protonix) and rabeprazole (Aciphex) which suppress gastric acid, will be given together with two antibiotics. The antibiotics used include amoxicillin (Amoxil), clarithromycin (Biaxin), metronidazole (Flagyl), and tetracycline. Bismuth subsalicylate is sometimes used instead of a proton pump inhibitor. Occasionally if triple therapy is unsuccessful, a treatment regimen involving four drugs may be used. Evidence shows that triple therapy can eradicate H. pylori in around 80–85% of cases.

The main reason why H. pylori eradication fails is that patients do not always take their medication as prescribed. It is very important for you to take all your tablets every day as directed. Unfortunately, many people suffer side effects from therapy. The side effects may include diarrhea, nausea, a metallic taste, and sometimes a severe inflammation of the bowel. However, if you can tolerate any side effects that you experience and persist with the course of treatment, then H. pylori should be eradicated for good. If you stop half way through a course, your ulcer and all the problems that occur as a result of it will return. You may also be left with a drug-resistant strain of H. pylori that cannot easily be treated with further antibiotics. If you cannot tolerate the side effects of treatment, you should check with your doctor before stopping the course. Long-term ulcer sufferers are at risk of perforation of the lining of the stomach or duodenum, and are also at risk of bleeding from the gastrointestinal tract. There is also increasing evidence that infection with H. pylori is associated with cancer of the stomach. Therefore, it is important to identify and treat H. pylori infection.

Further information
National Digestive Diseases Information Clearinghouse (NDDIC): http://www.digestive.niddk.nih.gov/ddiseases/pubs/hpylori/index.aspx

Last Reviewed: May 2013