Helicobacter pylori eradication protocols

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Helicobacter pylori eradication protocols is a standard name for all treatment protocols for peptic ulcers and gastritis; the primary goal is not only temporary relief of symptoms, but also total elimination of Helicobacter pylori infection.


A good, clinically useful H. pylori eradication protocol is a treatment protocol which ensures at least 80% H. pylori eradication rate, is not longer than 14 days (preferably 7 or 10 days), and is not too toxic (side effects should occur in no more than 10–15% patients receiving treatment by this protocol, and should not be so severe to warrant treatment discontinuation).

Because the bacterium detects acid gradients to move beneath the stomach lining, a drug commonly used to treat acid reflux is used to coax H. pylori back to the surface.[citation needed]

The treatment regimen should also be easy to follow by patients, both human and canine, to improve or maintain high rate of treatment compliance.

During the last few decades, several new eradication protocols have been developed. This allowed clinicians to target several goals:

  • improved treatment compliance;
  • sharpened dietary component;[1][2][contradiction]
  • no need to strictly follow a diet, due to new proton pump inhibitor efficacy;
  • decreased duration of therapy: from 14 to 7–10 days;
  • decreased number of different tablets to ingest, due to combined standard preparations;
  • decreased number of daily tablets from four times a day to twice-daily schemes;
  • lessened toxicity and probability of side effects;
  • improved clinical efficacy in terms of H. pylori eradication ratios;
  • overcoming the problem of antibiotic resistance;
  • satisfied the need for alternative protocols for those patients who are allergic to one of the standard antibiotics used in standard protocols.


One of the first "eradication protocols", if not the first, was used by Barry Marshall to treat his own gastritis, which developed following intentional ingestion of H. pylori culture. He used bismuth salt and metronidazole. This treatment effectively cured his gastritis and eliminated the H. pylori infection. But in terms of modern eradication protocol definition, which requires not only occasional ability to cure the infection, but also at least 80% eradication rate, this protocol cannot be described as "eradication protocol" and is not clinically reasonable.[citation needed][original research?]

One of the first "modern" eradication protocols was a one-week triple therapy, which the Sydney gastroenterologist Thomas Borody formulated in 1987.[3] As of 2006, a standard triple therapy is amoxicillin, clarithromycin, and a proton pump inhibitor such as omeprazole,[4] lansoprazole, pantoprazole, or esomeprazole. Protocols with metronidazole were also in use.[4]

An example of a fixed-dose combination is PantoPac, containing pantoprazole, clarithromycin, and amoxicillin.


  1. ^ Galan, MV; Kishan, AA; Silverman, AL (2004). "Oral broccoli sprouts for the treatment of Helicobacter pylori infection: A preliminary report". Digestive diseases and sciences 49 (7–8): 1088–90. doi:10.1023/B:DDAS.0000037792.04787.8a. PMID 15387326 
  2. ^ Keenan, JI; Salm, N; Hampton, MB; Wallace, AJ (2010). "Individual and combined effects of foods on Helicobacter pylori growth". Phytotherapy research : PTR 24 (8): 1229–33. doi:10.1002/ptr.3167. PMID 20658571 
  3. ^ Borody, Thomas J.; P. Cole; S. Noonan; A. Morgan; J. Lenne; L. Hyland; S. Brandl; E. G. Borody; L. L. George (October 16, 1989). "Recurrence of duodenal ulcer and Campylobacter pylori infection after eradication". Medical Journal of Australia 151 (8): 431–435. PMID 2687668. 
  4. ^ a b Mirbagheri, Seyed Amir; Mehrdad Hasibi; Mehdi Abouzari; Armin Rashidi (August 14, 2006). "Triple, standard quadruple and ampicillin–sulbactam-based quadruple therapies for H pylori eradication: A comparative three-armed randomized clinical trial". World Journal of Gastroenterology 12 (30): 4888–4891. PMID 16937475. Retrieved 2006-09-30.