Almost all treatment recommendation for gastritis, duodenitis or peptic ulcer that has Helicobacter pylori, calls for 2 or 3 antibiotic at the same time, why is that ?
Why not use a single effective antibiotic?
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because there's no single effective antibiotic .. you'd need to culture the bug to ascertain sensitivities before treatment. Simpler to use triple therapy.– Graham ChiuSep 30, 2017 at 21:57
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1@GrahamChiu This does not look like a comment but like something that might be put into an answer. With a bit more words and references, you know.– LаngLаngСOct 1, 2017 at 15:47
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1 Answer
The aim of taking two antibiotics at the same is to prevent an overgrowth of the H. pylori strains that could be resistant to a single antibiotic. The antibiotic choice depends on the individual sensitivity to antibiotics.
Various treatment regimes have been proposed: Helicobacter pylori treatment: antibiotics or probiotics (Applied microbiology and biotechnology, 2018).
A standard treatment regime for the H. pylori infection of the stomach is a triple therapy for 10-14 days:
- a proton pump inhibitor, such as omeprazole (or ranitidine bismuth citrate)
- the antibiotic clarithromycin (or levofloxacin in case of resistance)
- the antibiotic amoxicillin (or metronidazole)
Probiotics taken along with triple therapy can increase the eradication rate.
In recent years, the effectiveness of the triple regime has fallen from 90% to <70% due to resistance of H. pylori to multiple antibiotics. The reported prevalence of resistance to:
- metronidazole: ~10% in Japan, 17 to 44% in Europe and America, 50-100% in Africa
- clarithromycin: 16% in Japan, 1.7 to 23.4% in Europe, 10.6 to 25% in North America
Suggested new therapies
Quadruple therapy (for areas with high incidence of clarithromycin resistance):
- a proton pump inhibitor
- bismuth citrate
- the antibiotic tetracycline
- the antibiotic metronidazole
The efficacy of the quadruple therapy in H. pylori eradication is similar than in triple therapy (~77%).
Sequential therapy uses the same drugs as the triple therapy but not at the same time (more effective in patients with the single clarithromycin-resistant strain; eradication rates were 80.9% for sequential therapy and 40.7% for standard triple therapy):
- 5 days with a proton pump inhibitor plus amoxicillin followed by
- 5 days of a proton pump inhibitor plus clarithromycin and amoxicillin
