Home > Gastroenterology > H. Pylori

Diagnosis of Active Infection
Urea Breath Test. Patients should be off proton pump inhibitors two weeks prior to a urea breath test.
H. pylori Stool Antigen

Treatment Regimens

10 Day Triple Therapy : Pantoprazole 40 mg PO BID, Clarithromycin 500 mg PO BID, Amoxicillin 1 gm PO BID

10 Day Quadruple Therapy: Esomeprazole 40 mg PO BID, Metronidazole 500 mg PO TID, Tetracycline 500 mg PO QID, Bismuth Subcitrate 240 mg PO BID. Consider this regimen in areas with high Clarithromycin resistance.

10 Day Sequential Therapy: 5 Days of Pantoprazole 40 mg PO BID and Amoxicillin 1 gm PO BID followed by 5 days of Pantoprazole 40 mg PO BID, Clarithromycin 500 mg PO BID, and Tinidazole 500 mg PO BID.

5 Day Quadruple Concomitant Therapy: Esomeprazole 40 mg PO BID, Amoxicillin 1 gm PO BID, Levofloxacin 500 mg PO BID, Tinidazole 500 mg PO BID. This regimen had a greater than 90% eradication rate.

After multiple treatment failures, consider obtaining a gastric biopsy H. pylori culture and susceptibility testing.

Please consider an official gastroenterology consult and refer to the sources below.

Sources:
1. Management of Helicobacter pylori infection—the Maastricht IV/ Florence Consensus Report
2. Efficacy of 5-Day Levofloxacin-Containing Concomitant Therapy in Eradication of Helicobacter pylori Infection

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