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Drugs to get rid of H. pylori (eradication treatment)

BMJ Group Medical Reference

Introduction

This information is for people who have H. pylori infection. It tells you about drugs to get rid of H. pylori (eradication treatment). It is based on the best and most up-to-date research.

Does it work?

Yes, there's good evidence that taking antibiotics plus acid-suppressing drugs will get rid of H. pylori.

Doctors use lots of different combinations of drugs for this. Most seem to work equally well.

What is it?

If you have treatment to get rid of H. pylori, you'll probably be given three or four drugs. You'll take these drugs every day for up to two weeks. Doctors call this eradication treatment because it's meant to eradicate, or get rid of, H. pylori bacteria from your stomach.

The National Institute for Health and Clinical Excellence (NICE), which advises the government on which drugs should be available on the NHS, says people being treated to get rid of H. pylori should take a drug called a proton pump inhibitor plus two antibiotics. [10]

Proton pump inhibitor drugs reduce the amount of acid made by the cells in your stomach. Antibiotics kill the H. pylori bacteria in your stomach.

Proton pump inhibitors include the following:

  • esomeprazole (brand name Nexium)

  • lansoprazole (Zoton)

  • omeprazole (Losec)

  • pantoprazole (Protium)

  • rabeprazole (Pariet).

There are many different types of antibiotics. But the antibiotic combinations that are recommended by NICE are: [10]

  • metronidazole and clarithromycin

  • amoxicillin and clarithromycin.

Your doctor will choose the drugs most appropriate for you. Some people can't take amoxycillin because of allergies. And some people get worse side effects from metronidazole.

Also, if you've recently taken one of these antibiotics for another condition, the H. pylori bacteria in your stomach might be resistant to it. That means it no longer works. So your doctor will prescribe a different antibiotic.

H. pylori eradication treatment works for people with H. pylori infection who have stomach ulcers or duodenal ulcers, or long-term indigestion pain not caused by an ulcer. To find out more about who needs treatment, read Who is treated for H. pylori?

You might also take a fourth drug, called bismuth. This drug protects the lining of your stomach.

How can it help?

Eradication treatment is very likely to get rid of the H. pylori bacteria in your stomach. However, there's some uncertainty about how many drugs to take, which combinations work best, and how long you need to take them for.

This is what we know from research:

  • Taking two antibiotics plus an acid-suppressing drug works better than taking one antibiotic plus an acid-suppressing drug. [19] [20] [21]

  • If taking three drugs doesn't work, taking four drugs may work better. The fourth drug is bismuth. [22] [23] [24] But for most people, three drugs is enough. [25]

  • Taking drugs for two weeks may work better than for one week. [26] [27] About 8 in 10 people who take drugs for two weeks get rid of H. pylori, compared to only 7 in 10 people who take treatment for just one week. [28]

  • We don't know which exact combination of drugs works best. Most of the commonly-used combinations seem to work as well as each other. [29]

  • Taking two drugs for five days, then three drugs for five days, may work better than taking three drugs for one week. [30]

Last Updated: July 10, 2012
This information does not replace medical advice.  If you are concerned you might have a medical problem please ask your Boots pharmacy team in your local Boots store, or see your doctor.

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