Triple Therapy for H Pylori
H pylori is a bacterium that colonizes the stomach and is the leading cause of peptic ulcers. H pylori also has been linked to increased rates of gastric cancer. As a result, once an H pylori infection is detected, medication is usually prescribed to eradicate it. The most popular combination of drugs is known as triple therapy.
Triple Therapy for H Pylori
Unlike many other bacterial infections, H pylori requires a course of several medications to be eradicated. H pylori is a survivor; it has adapted to live in the harsh conditions of the stomach and also has adapted to the use of regular antibiotics. As a result, several medications are used together in a treatment plan commonly called triple therapy.
Triple Therapy Medications
Triple therapy typically consists of two antibiotics and one proton-pump inhibitor. The two antibiotics are used to take out H pylori whereas the proton-pump inhibitor promotes healing of damaged tissue in the stomach. The usage of a proton-pump inhibitor is also thought to weaken H pylori.
The actual choice of medications varies from region to region and doctor to doctor. Many types of antibiotics and proton-pump inhibitors have proven to be effective in H pylori treatment.
The combination approach is used because a single antibiotic is not effective at combating H pylori. In fact, one study attempted to replace one of the antibiotics with fish oil and the success rate for treatment dropped from over 80% to under 40% (1).
Triple Therapy for H Pylori Success Rate
As you can see from the study above, triple therapy for H pylori does not have a 100% success rate. This is not unusual; the success rate of any antibiotic therapy typically decreases over time as the bacteria develops resistance to the medications used.
As a result “Quadruple Therapy”, which involves adding in a fourth medication, has increased in popularity over the years to help combat particularly resistant H pylori infections. However, triple therapy for H pylori is still the gold standard and is much more studied than quadruple therapy.
One of the more intriguing new treatment methods is sequential therapy. This involves the some of the same medications as triple therapy but rather than taking them all at one, they are taken in a specific sequence. An initial trial saw that sequential therapy had success rates of over 90% (2). This is an area that certainly deserves more research in the future.
Life After Triple Therapy for H Pylori
If you received triple therapy for H pylori, there are a few things to keep in mind:
- H pylori typically has no symptoms; most reported H pylori symptoms are actually stomach ulcer symptoms. As a result, you may not necessarily “feel better” as soon as H pylori is eradicated. If you have an ulcer, it will take some time for it to heal before you feel better.
- Triple therapy is a strong course of antibiotics and as such it wipes out the “good” bacteria in the digestive tract. Taking a probiotic can help restore these good bacteria. Make sure the probiotic contains Lactobacillus and Bifidobacterium as these have been shown to help combat H pylori infection when taken with triple therapy (3,4,5).
- Triple therapy does not have a 100% success rate. H pylori can become “suppressed” by triple therapy. Suppressed bacteria are not active and cannot be detected easily by an urea breath test. As a result, it is recommended to be retested for H pylori infection both 4 and 12 weeks after triple therapy.
1. Meier R, Wettstein A, Drewe J, Geiser HR. Fish oil (Eicosapen) is less effective than metronidazole, in combination with pantoprazole and clarithromycin, for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2001 Jun;15(6):851-5..
2. Vaira D et al. Sequential therapy versus standard triple-drug therapy for Helicobacter pylori eradication: A randomized trial. Ann Intern Med 2007 Apr 17; 146:556-63.
3. de Bortoli N et al. Helicobacter pylori eradication: a randomized prospective study of triple therapy versus triple therapy plus lactoferrin and probiotics. Am J Gastroenterol. 2007 May;102(5):951-6.
4. Sheu BS, Wu JJ, Lo CY, Wu HW, Chen JH, Lin YS, Lin MD. Impact of supplement with Lactobacillus- and Bifidobacterium-containing yogurt on triple therapy for Helicobacter pylori eradication. Aliment Pharmacol Ther. 2002 Sep;16(9):1669-75.
5. Kim MN et al. The effects of probiotics on PPI-triple therapy for Helicobacter pylori eradication. Helicobacter. 2008 Aug;13(4):261-8.