## H. pylori Eradication Therapy **Key Point:** Triple therapy with a proton pump inhibitor (PPI) + two antibiotics is the gold-standard first-line regimen for H. pylori eradication. ### Standard Triple Therapy Regimen **High-Yield:** The most commonly used triple therapy is: - **Omeprazole** (or lansoprazole) 20 mg BD - **Amoxicillin** 1 g BD - **Clarithromycin** 500 mg BD - Duration: 7–14 days ### Why This Combination? | Component | Role | Mechanism | |-----------|------|----------| | Omeprazole | PPI | Reduces gastric acid, creates alkaline environment for antibiotic efficacy | | Amoxicillin | β-lactam antibiotic | Bactericidal; active against H. pylori | | Clarithromycin | Macrolide antibiotic | Bactericidal; synergistic with amoxicillin | **Clinical Pearl:** The PPI is essential not only for ulcer healing but also to optimize antibiotic penetration into the gastric mucosa and achieve eradication rates >90%. ### Alternative Regimens If clarithromycin resistance is suspected or documented: - **Quadruple therapy:** PPI + bismuth + metronidazole + tetracycline (7–14 days) - **Sequential therapy:** PPI + amoxicillin (5 days), then PPI + clarithromycin + metronidazole (5 days) **Mnemonic:** **PAC** = **P**roton pump inhibitor + **A**moxicillin + **C**larithromycin **Warning:** Monotherapy (e.g., omeprazole alone) or dual therapy is inadequate and leads to treatment failure and antibiotic resistance. [cite:Harrison 21e Ch 297]
Sign up free to access AI-powered MCQ practice with detailed explanations and adaptive learning.