Helicobacter Pylori Infection Medication

Updated: Oct 12, 2017
  • Author: Luigi Santacroce, MD; Chief Editor: BS Anand, MD  more...
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Medication

Medication Summary

The goals of pharmacotherapy are to eradicate the microorganism, to prevent complications, and to reduce morbidity. Triple therapies are used. Worldwide, accepted treatment regimens are BMT, LAC, and OAC. BMT regimen is based on the administration of bismuth subsalicylate, metronidazole, and tetracycline. Add an H2-receptor antagonist for an additional 4 weeks. LAC regimen is based on the administration of lansoprazole, amoxicillin, and clarithromycin. OAC regimen is based on the administration of omeprazole, amoxicillin, and clarithromycin.

Increasing resistance to antibiotics has made alternative treatments necessary. In a phase 3 trial conducted by Malfertheiner et al, quadruple therapy (omeprazole plus a single 3-in-1 capsule containing bismuth subcitrate potassium, metronidazole, and tetracycline) was tested against standard therapy in adults with H pylori infection. [17] This study suggests quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy.

As noted, 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. [18, 19]  In such cases treatment with rifabutin may be indicated.

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Antidiarrheals

Class Summary

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

Bismuth subsalicylate (Bismatrol, Pepto-Bismol)

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 <1 h. Such deposits induce distortion and vacuolization of the bacterial cell and loss of adherence of H pylori from antral epithelium.

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Antibiotics

Class Summary

Use agents known to be effective against H pylori.

Metronidazole (Flagyl)

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)

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

Clarithromycin (Biaxin)

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

Amoxicillin (Amoxil, Trimox)

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.

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Proton pump inhibitors

Class Summary

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

Lansoprazole (Prevacid)

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

Omeprazole (Prilosec)

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

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H2 receptor blockers

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)

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)

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

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