Quadruple Therapy for H.pylori

Is a Gram-negative, microaerophilic bacterium that can inhabit various areas of the stomach, particularly the antrum. It causes a chronic low-level inflammation of the stomach lining and is strongly linked to the development of duodenal and gastric ulcers and stomach cancer.  H pylori infection causes atrophic and even metaplastic changes in the stomach.The bacterial adhesion appears to result in tyrosine phosphorylation and is specific for gastric cells.

No specific clinical signs have been described in patients with H pylori infection

·         Patients may feel dyspepsia or abdominal discomfort, such as during gastritis or with epigastric pain (eg, duodenal ulcers).

·         In some cases, patients may feel hungry in the morning and may have halitosis.

Surgery is not required for patients with H pylori infection, but it may be considered in patients with severe complications, such as cancer. No dietary restrictions are usually needed. No limitations of physical activity are needed if patients do not have complications.

The goals of pharmacotherapy are to eradicate the microorganism, to prevent complications, and to reduce morbidity. Triple therapies are used. Worldwide, accepted treatment regimens are BMT, LAC, and OAC.

·         BMT regimen is based on the administration of bismuth subsalicylate, metronidazole, and tetracycline. Add an H2-receptor antagonist for an additional 4 weeks.

·        LAC regimen is based on the administration of lansoprazole, amoxicillin, and clarithromycin.

·         OAC regimen is based on the administration of omeprazole, amoxicillin, and clarithromycin.

In case of allergic to penicillin, replacing amoxicillin with metronidazole.

Even with the recommended triple regimens, H. pylori eradication failure is still seen in more than 20% of patients.

Increasing resistance to antibiotics has made alternative treatments necessary.  This study suggests quadruple therapy provides superior eradication with similar safety and tolerability to standard therapy. It is generally reserved for patient in whom the standard course of treatment has failed. Consider maintenance therapy with half of the standard doses of H2-receptor antagonists at bedtime in patients with recurrent, refractory, or complicated ulcers, particularly if cure of H pylori-negative ulcer is present. 

The quadruple therapy includes the following drugs, administered for 14 days:





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