logo
infectious disease header

Infection

Gastric Ulcer Possible therapeutic alternatives
H. pylori
( Helicobacter Pylori )
 
TREATMENT REGIMENS 
THREE DRUG REGIMENS 
Proton pump inhibitor (PPI) orally twice daily + Clarithromycin 500mg orally twice daily + Amoxicillin 1gm orally twice daily [Available as Prevpac using PPI lansoprazole]. Eradication 85-90%. Duration 10-14 days*
Bismuth subsalicylate 525mg four times daily + Tetracycline 500mg four times daily + Metronidazole 500mg orally 3 to 4 times daily.  Duration=14 days*. Cheapest option (about $15), but efficacy reduced without PPI.
Proton pump inhibitor orally twice daily + Clarithromycin 500mg orally twice daily + Metronidazole 500mg orally twice daily. Duration 10-14 days [for PCN allergic pts]
Ranitidine bismuth citrate 400mg orally twice daily + Clarithromycin 500mg orally twice daily + Amoxicillin 1gm orally twice daily Duration= 7-10 days
PPI orally twice daily + Amoxicillin 500mg orally twice daily-orally three times daily + Metronidazole 500mg orally 2 or 3 times daily x 10-14d
Ranitidine bismuth citrate 400mg orally twice daily + Clarithromycin 500mg orally twice daily + Metronidazole 500mg orally twice daily. Duration= 7 days
* denotes FDA approved regimens. PPI's = omeprazole 20mg, lansoprazole 30mg, pantoprazole 40mg, rabeprazole 20mg, esomeprazole 40mg ALL PO orally twice daily.
TWO DRUG REGIMENS (FDA APPROVED) 
Dual therapy well-studied, but lower eradication rates (60-85%) make them second tier options.
PPI + either clarithromycin 500 mg orally three times daily OR Amox 1gm orally twice daily for 2 weeks then PPI for 2 more weeks (PPI = omeprazole 40mg QD or lansoprazole 30mg orally three times daily)
Ranitidine bismuth citrate (RBC) 400 mg orally twice daily + clarithromycin 500 mg orally three times daily OR orally twice daily for 2 weeks then RBC for 2 more weeks
FOUR DRUG REGIMEN
Proton pump inhibitor orally twice daily + Bismuth subsalicylate 525mg four times daily + Tetracycline 500mg four times daily + Metronidazole 500mg orally 3 to 4 times daily. Duration 2 weeks

Images

Gastric Ulcer

Bleeding Ulcer

References - Infectious Disease Section

Infectious Disease References

Disclaimer

The authors make no claims of the accuracy of the information contained herein; and these suggested doses are not a substitute for clinical judgement. Neither GlobalRPh Inc. nor any other party involved in the preparation of this program shall be liable for any special, consequential, or exemplary damages resulting in whole or part from any user's use of or reliance upon this material.
PLEASE READ THE DISCLAIMER CAREFULLY BEFORE ACCESSING OR USING THIS SITE. BY ACCESSING OR USING THIS SITE, YOU AGREE TO BE BOUND BY THE TERMS AND CONDITIONS SET FORTH IN THE DISCLAIMER.   
Read the disclaimer
more Career Center image description
Medical Calculators - A thru Z
Lab Values - A thru Z