Antibiotic regimens for H pylori infection

1. Dual therapy uses omeprazole (a proton pump inhibitor) in combination with metronidazole (Flagyl) and clarithromycin (Biaxin). This regimen is >90% effective in H. pylori eradication and is simpler than Triple Therapy.

2. Triple therapy uses Pepto Bismol in combination with metronidazole and either tetracycline or amoxicillin. This regimen is effective in eradicating H. pylori infection in >90%. It is inexpensive, but has the disadvantage of being complicated.

Antibiotic Regimens for H Pylori Infection

Dual Therapy

Triple Therapy

Omeprazole (Prilosec) 20 mg bid.

Metronidazole (Flagyl) 500 mg bid.

Clarithromycin (Biaxin) 250 mg bid.

10 days of therapy is 95% effective. If active ulcer, continue omeprazole, 20 mg qd, for an additional 2-3 weeks.

Pepto-Bismol 2 tablets qid. Metronidazole 250 mg qid. Tetracycline or Amoxicillin 500 mg qid.

14 days of therapy is 95% effective. If active ulcer, treat with H2-blocker for 4-6 weeks.

B. Follow-up after treatment of H pylori. Patients with uncomplicated peptic ulcer disease treated for H pylori infection do not require a "test of cure" to confirm eradication of H. pylori. However, if their symptoms return, further evaluation for recurrent or persistent H. pylori infection is required.

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