## H. pylori Eradication Therapy in Peptic Ulcer Disease **Key Point:** Triple therapy combining a proton pump inhibitor (PPI) with two antibiotics is the gold-standard first-line regimen for H. pylori eradication in peptic ulcer disease. ### Standard Triple Therapy Regimen **High-Yield:** The most widely recommended and effective triple therapy consists of: - **Proton pump inhibitor** (omeprazole, lansoprazole, or pantoprazole) - **Amoxicillin** (or metronidazole if penicillin-allergic) - **Clarithromycin** (or metronidazole as alternative) This combination achieves eradication rates of 85–95% when compliance is maintained. ### Mechanism of Action | Component | Role | Mechanism | |-----------|------|----------| | PPI (Omeprazole) | Acid suppression | Inhibits H^+^/K^+^-ATPase; creates alkaline environment for antibiotic penetration | | Amoxicillin | Bactericidal antibiotic | β-lactam; disrupts bacterial cell wall | | Clarithromycin | Bactericidal antibiotic | Macrolide; inhibits bacterial protein synthesis | **Clinical Pearl:** The PPI is essential not only for symptom relief but also to reduce gastric acidity, which enhances antibiotic bioavailability and H. pylori susceptibility. ### Duration and Compliance **Key Point:** Standard triple therapy is administered for **7–14 days** (typically 10 days in India). Compliance is critical—incomplete courses lead to antibiotic resistance and treatment failure. ### Why This Regimen Works 1. **Synergistic effect:** The combination targets H. pylori through multiple mechanisms simultaneously. 2. **Resistance prevention:** Dual antibiotic coverage reduces the likelihood of resistance emergence. 3. **Acid suppression:** PPI-induced hypochlorhydria creates an optimal milieu for antibiotic penetration into gastric mucosa. **Mnemonic:** **PAC** = **P**roton pump inhibitor + **A**moxicillin + **C**larithromycin [cite:Harrison 21e Ch 297]
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