Sections

Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the microorganism, to prevent complications, and to reduce morbidity. Triple therapies are used.

Increasing resistance to antibiotics has made alternative treatments necessary. Antibiotic resistance phenomena are now observed with a certain frequency in H pylori infections; occasionally, even after the use of different eradicating protocols, H pylori is not eradicated.^{[20, 21]}In such cases treatment with rifabutin may be indicated.

On April 1, 2020, the US Food and Drug Administration (FDA) recommended the immediate withdrawal of ranitidine from the market based on findings of unacceptable levels of N-Nitrosodimethylamine (NDMA), a possible carcinogen.^[22]In July, 2021, the original report was retracted at the request of the authors.^[23]The FDA may consider allowing ranitidine products back on the market if they are proven stable during storage and NDMA amounts do not increase to unsafe levels over time.^{[24, 25]}

Several studies are underway to elucidate the role of nanotechnology in the treatment of H pylori infection using nanoparticles synthesized with antibiotics or other agents.^{[26, 27, 28, 29]}

Class Summary

The approved antidiarrheal for this infection is bismuth subsalicylate. It has both antisecretory and antimicrobial activity.

Bismuth subsalicylate (Bismatrol, Pepto-Bismol)

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Has cytoprotective effect on the GI mucosa, probably due to the stimulation of prostaglandin production and modulation of the immune response. In addition, it has been demonstrated that some deposits (probably bismuth salts) appear on both surfaces of the cell wall of H pylori after H pylori</i> from antral epithelium.

Class Summary

Use agents known to be effective against H pylori.

Metronidazole (Flagyl)

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Reduced to its active form intracellularly only by anaerobic organisms, then disrupts the helical structure of DNA and inhibits bacterial nucleic acid synthesis.

Tetracycline (Sumycin)

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Inhibits bacterial protein synthesis by binding with 30S and possibly 50S ribosomal subunit(s).

Clarithromycin (Biaxin)

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Inhibits bacterial growth, possibly by blocking the dissociation of peptidyl tRNA from ribosomes, causing the arrest of RNA-dependent protein synthesis.

Amoxicillin (Amoxil, Trimox)

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Inhibits the final stage of bacterial cell wall synthesis by binding to specific PBPs on the inner part of the bacterial wall, leading to bacterial lysis.

Class Summary

Bind to proton pump of parietal cells, inhibiting the secretion of hydrogen ions into the gastric lumen. Relieve pain and heal peptic ulcers more rapidly than H2 antagonists.

Lansoprazole (Prevacid)

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Works by inhibiting the H⁺/K⁺ -ATPase enzyme system of the gastric parietal cells.

Omeprazole (Prilosec)

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Decreases gastric acid secretion by inhibiting parietal cell H⁺/K⁺ -ATP pump.

Class Summary

Reversible competitive blockers of histamine at H2 receptors, particularly those in the gastric parietal cells, wherein they inhibit acid secretion. H2 antagonists are highly selective, do not affect the H1 receptors, and are not anticholinergic agents. Proton pump inhibitors are usually preferred.

Ranitidine (Zantac)

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Reduces basal and nocturnal gastric acid secretion by competitive inhibition of binding of histamine to receptors (H2 receptor) on the gastric parietal cells. Although not effective as single agents for the eradication of H pylori, appears to increase the systemic absorption of bismuth subsalicylate.

Famotidine (Pepcid)

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Competitively inhibits histamine at H2 receptor of gastric parietal cells, resulting in reduced gastric acid secretion, gastric volume, and hydrogen ion concentrations.

Class Summary

Combinations allow ease of administration and promote enhanced patient adherence.

Amoxicillin/omeprazole/rifabutin (Talicia)

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Combination delayed-release capsules contains amoxicillin, omeprazole, and rifabutin is administered as an every 8 h regimen. It is indicated for treatment of H pylori infection in adults.

Lansoprazole/amoxicillin/clarithromycin (Prevpac)

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Copackaged product containing a PPI, a macrolide antimicrobial, and a penicillin class antibacterial as a twice-daily regimen. Indicated for H pylori eradication to reduce the risk of duodenal ulcer recurrence.

Omeprazole/amoxicillin/clarithromycin (Omeclamox-Pak)

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Copackaged product containing a PPI, a macrolide antimicrobial, and a penicillin class antibacterial. It is indicated for treatment of patients with H pylori infection and duodenal ulcer disease (active or up to 1-year history) to eradicate H pylori. It is a twice-daily regimen.

Questions

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Media Gallery

Helicobacter Pylori Infection. This image shows an antral gland of the stomach with a large Giemsa-stained colony of Helicobacter pylori in the lumen (arrow) at 250X power. Courtesy of Pantaleo Bufo, University of Foggia, Italy.
Helicobacter Pylori Infection. A lamina propria of the stomach is shown with two mast cells overlapping each other. Note the upper part reveals the degranulating process with the release of granules of inflammation mediators (Giemsa staining, 250X). Courtesy of Pantaleo Bufo, University of Foggia, Italy.
Helicobacter Pylori Infection. A transverse section of the gastric lamina propria is shown. In the lower part, an antral gland of the stomach is present with some Helicobacter pylori in the lumen (red-blue arrow). In the upper part, a mast cell (yellow arrow) is present (Giemsa staining, 250X). Courtesy of Pantaleo Bufo, University of Foggia, Italy.
Helicobacter Pylori Infection. An antral gland of the stomach is shown with a large colony of Helicobacter pylori in the lumen (Giemsa staining, 425X). Courtesy of Pantaleo Bufo, University of Foggia, Italy.

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Helicobacter Pylori Infection Medication

Medication Summary

Antidiarrheals

Class Summary

Bismuth subsalicylate (Bismatrol, Pepto-Bismol)

Bismuth subsalicylate (Bismatrol, Pepto-Bismol)

Antibiotics

Class Summary

Metronidazole (Flagyl)

Metronidazole (Flagyl)

Tetracycline (Sumycin)

Tetracycline (Sumycin)

Clarithromycin (Biaxin)

Clarithromycin (Biaxin)

Amoxicillin (Amoxil, Trimox)

Amoxicillin (Amoxil, Trimox)

Proton pump inhibitors

Class Summary

Lansoprazole (Prevacid)

Lansoprazole (Prevacid)

Omeprazole (Prilosec)

Omeprazole (Prilosec)

H2 receptor blockers

Class Summary

Ranitidine (Zantac)

Ranitidine (Zantac)

Famotidine (Pepcid)

Famotidine (Pepcid)

Combination Products

Class Summary

Amoxicillin/omeprazole/rifabutin (Talicia)

Amoxicillin/omeprazole/rifabutin (Talicia)

Lansoprazole/amoxicillin/clarithromycin (Prevpac)

Lansoprazole/amoxicillin/clarithromycin (Prevpac)

Omeprazole/amoxicillin/clarithromycin (Omeclamox-Pak)

Omeprazole/amoxicillin/clarithromycin (Omeclamox-Pak)

Helicobacter Pylori Infection Medication

Medication Summary

Antidiarrheals

Class Summary

Bismuth subsalicylate (Bismatrol, Pepto-Bismol)

Antibiotics

Class Summary

Metronidazole (Flagyl)

Tetracycline (Sumycin)

Clarithromycin (Biaxin)

Amoxicillin (Amoxil, Trimox)

Proton pump inhibitors

Class Summary

Lansoprazole (Prevacid)

Omeprazole (Prilosec)

H2 receptor blockers

Class Summary

Ranitidine (Zantac)

Famotidine (Pepcid)

Combination Products

Class Summary

Amoxicillin/omeprazole/rifabutin (Talicia)

Lansoprazole/amoxicillin/clarithromycin (Prevpac)

Omeprazole/amoxicillin/clarithromycin (Omeclamox-Pak)

References

Tables

Contributor Information and Disclosures

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