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Clinical Information
- ACP Journal Club
- PIER does not note sequential therapy
- UpToDate does not note sequential therapy
Patient Information
- None found on sequential therapy
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Clinical Information
- ACP Journal Club
- PIER
| PIER (as of 1/25/2007): |
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From: Peptic Ulcer Disease: Drug Therapy 
| (© - subscription required) |
Authors: Koss M et al. |
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- Recognize that, in the presence of documented gastric or duodenal ulcers, eradication of active H. pylori infection will allow for ulcer healing and will reduce the risk of recurrent ulcers.
- Consider proton-pump inhibitor-based triple therapy:
- A proton-pump inhibitor (e.g., lansoprazole, 30 mg, bid, or omeprazole, 20 mg, bid) plus two antibiotics, usually amoxicillin, 1 g, bid, and clarithromycin, 500 mg, bid
- The duration of therapy approved for the lansoprazole, amoxicillin, and clarithromycin regimen is 10 or, preferably, 14 days
- The expected eradication rate is reported to range from 86% to 94%
- Start all medications simultaneously
- Consider bismuth-based triple therapy:
- Bismuth subsalicylate, 2 tablets chewed, qid, plus metronidazole, 500 mg, tid to qid, plus tetracycline, 500 mg, qid, for 14 days
- Alternative use of amoxicillin-ampicillin to replace tetracycline is not recommended, as clinical trials show a significantly reduced eradication rate
- Because an acute ulcer is being treated, which is often associated with pain and other symptoms, note that co-administration of an acid-suppressive agent for at least 28 days is recommended
- Note that alternatives include standard doses of proton-pump inhibitors (e.g., omeprazole, 20 mg, qd, or lansoprazole, 30 mg, qd) or an H2 blocker (e.g., ranitidine, 150 mg, bid, famotidine, 20 mg, bid).
- Note that it is not necessary to continue chronic acid suppressive therapy to prevent recurrent peptic ulcer disease episodes.
- Be aware that it is imperative the patient complies with the regimen, not only for successful eradication of H. pylori, but also to avoid failure or persistent infection with antibiotic-resistant organisms.
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- UpToDate
| UpToDate (as of 1/10/2007): |
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From: Treatment regimens for Helicobacter pylori
| (© - subscription required) |
Authors: Peura D |
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For initial therapy, we recommend triple therapy with a proton pump inhibitor (eg, lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, pantoprazole 40 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 40 mg once daily), amoxicillin (1 g twice daily), and clarithromycin (500 mg twice daily) for two weeks (Grade 1A) (although several studies suggest that 10 days may be adequate).
- We suggest substitution of amoxicillin with metronidazole (500 mg twice daily) only in penicillin-allergic individuals since metronidazole resistance is common and can reduce the efficacy of treatment (Grade 2B).
- A proton pump inhibitor (PPI) twice daily can be combined with bismuth (525 mg four times daily) and two antibiotics (eg, metronidazole 500 mg four times daily and tetracycline 500 mg four times daily) for two weeks. Although this can be used as initial therapy, we suggest it mainly for retreatment (Grade 2B). One week of bismuth based treatment may be sufficient for initial therapy as long as it is given with a PPI.
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Patient Information
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