Overview of H. pylori eradication therapy in adults

Eradication therapy for Helicobacter pylori infection requires a combination of drugs. The regimens are the same irrespective of the indication for eradication therapy. The choice of regimen in a particular country is made based on knowledge of local antimicrobial resistance rates and the outcomes of locally conducted clinical trials. As antimicrobial resistance varies around the world, the recommended choice and duration of therapy also vary.

In Australia, first-line H. pylori eradication therapy is with clarithromycin-based triple therapy. If first-line therapy fails (see Assessing the outcome of H. pylori eradication therapy in adults), clarithromycin resistance is likely, so alternative (salvage) therapy is needed—see Failure of H. pylori eradication therapy in adults.

Individual pretreatment testing of antimicrobial susceptibility from cultured endoscopic biopsies is not routinely required because it has a limited role in guiding H. pylori eradication therapy. However, culture and susceptibility testing may be used by specialists following the failure of one or more lines of empirical therapy, and to track changes in antimicrobial resistance rates.