What is included in triple therapy for eradication of Helicobacter pylori infection?

Updated: Dec 09, 2020
  • Author: Joseph Adrian L Buensalido, MD; more...
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Answer

Answer

Triple therapy for H  pylori infection remains an option for first-line therapy in areas of low (< 15%) clarithromycin resistance [4] and consists of the following:

  1. Proton pump inhibitor (PPI) (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole 40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID) [2, 5]  plus

  2. Clarithromycin 500 mg BID [5] (first-line and continues to be recommended in areas where H pylori clarithromycin resistance is less than 15% and in patients without previous macrolide exposure [2] ​) or  metronidazole 500 mg BID [5] (when clarithromycin resistance is increasing) [6, 7]  plus

  3. Amoxicillin 1000 mg BID [5]  or  metronidazole 500 mg BID [8] (if not already selected)

Duration

A Cochrane meta-analysis of 55 studies concluded that 14 days is the optimal duration of triple therapy, achieving an H pylori eradication rate of 81.9%, whereas 7 days attains an eradication rate of only 72.9%. [9] In more recent studies, however, the eradication rate with 14-day triple therapy is not significantly different from that with 10-day sequential therapy (amoxicillin and a PPI for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days) [10]  or 10-day concomitant nonbismuth quadruple therapy. [11]


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