Combination drug therapy to treat a
peptic ulcer caused by
Helicobacter pylori (H. pylori) infection involves taking two antibiotics, a proton
pump inhibitor, and sometimes a bismuth compound.
You will need two different
antibiotics to treat your infection. It is important that the right combination
of antibiotics is selected, one that will kill the H. pylori. If the antibiotics are not effective, the bacteria may become
resistant to the action of some antibiotics, making
the infection harder to cure.
Some examples of antibiotics used
to treat H. pylori are:
Combination drug therapy regimens
therapy regimens commonly used to treat an H. pylori
infection include the following options:
- A proton pump inhibitor (PPI) plus clarithromycin plus amoxicillin or
- A proton pump inhibitor plus a bismuth
compound plus metronidazole plus
Prepackaged drug combinations
Some of the recommended drug combinations are
packaged together for convenience.
|bismuth subcitrate potassium and metronidazole and tetracycline
|bismuth subsalicylate and metronidazole and tetracycline
|lansoprazole (a PPI) and amoxicillin and clarithromycin
How It Works
The right antibiotics combinations
Helicobacter pylori (H. pylori) bacteria that are the cause of many peptic ulcers.
Two antibiotics are used because combination treatment works better and is less
likely to fail because of
resistance to the antibiotics.
Why It Is Used
Combination drug therapy that
includes at least two antibiotics, an acid reducer, and sometimes a bismuth
compound is recommended for people who have peptic ulcer disease and are known
to be infected with Helicobacter pylori (H. pylori).
How Well It Works
Helicobacter pylori (H. pylori) infections are cured 70% to 85% of the time when the right combination drug treatment is used.1
The side effects of antibiotics may
- Belly cramps.
- Nausea and
- Skin rash.
Proton pump inhibitors generally are well tolerated.
Headache and diarrhea are the most frequent side effects. These medicines may
interfere slightly with the actions of warfarin (Coumadin) and phenytoin
(Dilantin). Tell your doctor about all the medicines you are taking.
Proton pump inhibitors may have more serious side effects, too:
- They may reduce the amount of calcium your body
absorbs. This may be linked to an increased risk of broken bones.2
- They may make it more likely that you will get
If you are taking a bismuth compound along with an
antibiotic, your tongue or stool may appear darker (or even black). This is a
common side effect of bismuth compounds, and it is not harmful.
Drug Reference for a full list of side effects. (Drug Reference is not
available in all systems.)
What To Think About
It is very important that you
take all of the medicine prescribed. Do not stop taking your medicine even if
you feel better. It may seem like a lot of pills to take, but it is also
important to take a regimen that contains at least three medicines to cure
Helicobacter pylori (H. pylori).
Combination regimens are the most effective way to help ensure that
H. pylori bacteria do not develop resistance to the
antibiotics used to treat them.
If an H. pylori infection is not cured after one type of combination treatment,
you will need to take a different combination.
Some people who
have been treated for H. pylori infection need
follow-up testing to ensure that the infection is
Complete the new medication information form (PDF)(What is a PDF document?) to help you understand this medication.
Chey WD, et al. (2007). American College of
Gastroenterology guideline of the management of Helicobacter pylori infection. American Journal of Gastroenterology, 102(8): 1808-1825.
Yang YX, et al. (2006). Long-term proton pump
inhibitor therapy and risk of hip fracture. JAMA,