Helicobacter pylori Infection

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Treatment

Treatment for Helicobacter pylori infection often involves medications and lifestyle changes. In most cases, a "triple therapy" course of medications is used. This treatment consists of two antibiotics to destroy the bacteria and another type of medicine (e.g., bismuth subsalicylate) to promote healing and reduce symptoms. This combination of medicines generally is taken for 10 to 14 days.

Sometimes, four medications (called quadruple therapy) are used. This treatment involves using triple therapy medications in combination with a proton pump inhibitor (PPI) to prevent the stomach from producing acid. Quadruple therapy usually is administered for 1 week. This treatment may decrease rates of treatment failure caused by resistance to antibiotics.

Commonly prescribed antibiotics used to treat H. pylori infection include amoxicillin (Amoxil®, Trimox®), clarithromycin (Biaxin®), metronidazole (Flagyl®), and tetracycline (Sumycin®).

To work with the antibiotics, physicians often prescribe one or more of the following:

• Proton pump inhibitors (PPIs) prevent the stomach from producing acid. Common types are Prilosec®, Nexium®, and Prevacid®.
• Histamine-2 (H-2) blockers keep the stomach from producing too much acid and decrease the amount of hydrochloric acid sent to the digestive tract. Common types are Pepcid®, Tagamet®, and Zantac®.
• Bismuth subsalicylate coats painful areas and protects them from acid to promote healing. Pepto-Bismol® is one type.

Treatment for H. pylori infection may involve taking as many as 20 pills each day. Some physicians prescribe combination drugs so patients are able to take fewer pills. For example, Tritec® includes both bismuth subsalicylate and an acid reducer, and Helidac® includes two antibiotics and bismuth subsalicylate. Drug combinations vary in different areas of the world because different strains of the bacteria are found in different regions.

It is important for patients to take the full course of medications exactly as directed. An improvement in symptoms does not necessarily mean that H. pylori bacteria are no longer present. Helicobacter pylori infection often can be cured on the first try if all medications are taken as prescribed. Not following instructions increases the risk for developing antibiotic-resistant strains of bacteria.

Side effects of medications used to treat H. pylori infection usually are not serious. They can be treated easily and may resolve on their own. Side effects depend on the type of medication used and include the following:

• Blackening of the tongue and stool
• Diarrhea
• Dizziness
• Headaches
• Metallic taste in the mouth
• Yeast infections in women

Patients who are taking metronidazole should avoid alcoholic beverages. When combined with alcohol, this drug can cause severe side effects, including headache, nausea and vomiting, flushing, sweating, and rapid heart rate.

While medication is the main treatment for H. pylori infection, lifestyle changes may help reduce symptoms. Physicians often recommend avoiding foods, beverages, and drugs that increase the production of stomach acid, since acid can hinder the treatment process. Cigarettes, aspirin, naproxen, ibuprofen, alcohol, and caffeine can worsen symptoms, as can spicy foods. Patients should avoid any foods that cause discomfort.

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