Standard first-line H. pylori eradication therapy in adults

Yuan, 2013 Nyssen, 2016 Malfertheiner, 2017 Fallone, 2016 Chey, 2017

A triple-therapy regimen combining a proton pump inhibitor (PPI) with amoxicillin and clarithromycin remains the preferred first-line Helicobacter pylori eradication therapy in Australia. Use¹:

For advice on duration of therapy, see Duration of therapy for first-line H. pylori eradication therapy in adults. For patients with hypersensitivity to penicillins, see First-line H. pylori eradication therapy for patients hypersensitive to penicillins.

This first-line regimen commonly achieves success rates of about 85 to 90% in clinical trials, but rates are lower in the primary care setting.

The most common reasons for treatment failure are incomplete adherence and pretreatment (primary) H. pylori resistance to clarithromycin. First-line therapy should not be repeated if treatment failure occurs (see Failure of H. pylori eradication therapy in adults)Chey, 2017.

H. pylori resistance to amoxicillin is very low. H. pylori resistance to metronidazole is very common in Australia (about 30 to 50% of H. pylori infections), so triple-therapy regimens containing a PPI (or bismuth), amoxicillin and metronidazole are not recommended as first-line therapy.

At the time of writing, there is no evidence to prefer the use of other proposed first-line therapies in Australia (including sequential, concomitant and hybrid therapies). Such therapies have been developed in countries where primary H. pylori resistance to clarithromycin is high and alternative first-line therapies are required. Clarithromycin-based triple therapy remains the preferred first-line treatment choice (unless local data show high rates of resistance).