Helicobacter pylori


First option (Preferred option): proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily) PLUS Biaxin 500mg orally twice daily PLUS  Amoxicillin 1 gram orally twice daily x 14 days.
Second option (penicillin allergic): proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily) PLUS  Biaxin 500mg orally twice daily PLUS  Flagyl 500mg orally twice daily x 14 days. 
Third option : proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily)  PLUS Pepto Bismol (2 tablets) orally four times daily  PLUS  flagyl 500mg orally three times daily for  14 days. 
Dual therapy regimens using a PPI plus one antibiotic (amoxicillin or clarithromycin) are frequently cited in the literature. However, they cannot be recommended as primary therapy because their eradication rates are significantly lower (60 to 85 percent) than the standard regimens.
Combination products: Helidac (bismuth subsalicylate + metronidazole + Tetracycline).  PrevPac (lansoprazole + amoxicillin + clarithromycin)

 

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David F. McAuley, Pharm.D., R.Ph.
GlobalRPh Inc.

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