Pharmacotherapy of Helicobacter pylori

Helicobacter pylori is a motile, spiral, microaerofile gram negative spirochyte that invades gastric mucosa. Helicobacter can be found in 30 to 55% of healthy population (more in elderly), but it can be found in 90 to 95% of patients with duodenal peptic ulcers and in 60 to 80% pacients in gastric peptic ulcers. The presence of Helicobacter increases the risk of stomach adenocarcinoma (class I. carcinogen by WHO. The pharmacotherapy of Helicobacter can improve the therapy of peptic ulcers.

Helicobacter pylori eradication protocols
The aim of the pharmacotherapy is to eradicate the Helicobacter pylori and thus improve the healing of the mucosa.

First-line therapy
For this purpose, a "triple combination" of drugs is used as a first-line choice. This therapy consists of a proton pump inhibitor (most commonly omeprazol, 2 × 20 mg/day, but other can be used too) and two antibiotics: clarithromycin (2 × 500 mg/day), and amoxicillin (1000 mg/day). If the patient is allergic to amoxicillin and/or other penicillin-derived drugs (beta-lactams), the amocycillin can be replaced with metronidazole (2 × 500 mg/day). This treatment should be taken daily for 14 days and leads to helicobacter eradication in ca. 70% of cases.

Second-line therapy
If the patient is alergic to clarithromycin, or the first line treatment has failed (possibly due to clarithromycin resistence, ca. 20% of cases), an alternative "quadruple therapy" treatment should be used instead (not common in the Czech Republic). This therapy consists of omeprazol (2 × 20 mg, or any other proton pump inhibitor), colloid bismuth (4 × 120 mg), tetracycline (4 × 500 mg), and metronidazole (2–3 × 500 mg). This therapy should be administered daily for 14 days and leads to Helicobacter eradication in more than 90% of patients.

Sequential therapy
Sequential therapy can be used when patients have recurrent helicobacter infections: omeprazol (2 × 20 mg), levofloxacin (2 × 500 mg) or amoxicilin (2 × 1000 mg) for first five days followed by omeprazol (2 × 20 mg), claritromycin (2 × 500 mg/day) a metronidazole (2 × 500 mg/day) for next five days.