Peptic Ulcer Disease
A Guide to the Best Treatments for H. Pylori: Antibiotics, PPI Medications, and More
The bacteria Helicobacter pylori is a common cause of stomach irritation and ulcers. Treatment is important to prevent potential health complications that come with the infection.
H. pylori infection is difficult to treat. The most effective treatments use 3 or 4 medications over a course of up to 2 weeks.
Natural treatments can’t cure H. pylori infections on their own. But they may make standard therapies more effective.
Helicobacter pylori is a bacteria that thrives in a place so acidic that scientists used to think no bacteria could live there. You guessed it — the stomach. And when it sets up shop, an infection can be quite difficult to cure. That’s why H. pylori treatments include multiple medications — and longer courses — than other infections.
Helicobacter pylori is better known as H. pylori. This bacteria infects the stomach and digestive tracts of half of the people on earth — that’s 4.4 billion people. H. pylori infections are very common in Africa, Latin America, and Asia. In the U.S., about 35% of people are infected.
The bacteria easily spreads among family members when they share food or utensils. And experts believe contaminated drinking water can also lead to infection.
For some people, H. pylori causes inflammation of the stomach lining (gastritis) or painful stomach or duodenal ulcers. Others don’t even know they’re infected because they feel fine.
But, regardless of symptoms, all people with H. pylori infections are at increased risk for stomach cancer (gastric cancer). So even though treatment for H. pylori is difficult, it’s important to prevent future health complications.
The first-choice treatment for H. pylori has traditionally been “triple therapy” — a combination of three medications. It’s a combination of antibiotics and an acid-blocking proton pump inhibitor (PPI). An example of a common combination for triple therapy is:
Clarithromycin: 500 mg twice per day for 14 days
Amoxicillin: 1,000 mg twice per day for 14 days
Omeprazole: 20 mg twice per day for 14 days
But there are alternative H. pylori treatment combinations. And the choice of medications for each person depends on several factors. Your provider will likely ask you the following questions:
Are you allergic to any of the medications (do you have a penicillin allergy)?
Have you taken the same type of antibiotics recently — or ever?
Does your local community have high rates of resistance to these antibiotics?
Antibiotic resistance is on the rise. And now an alternative H. pylori treatment — bismuth quadruple therapy — is also considered a first-choice treatment. It combines two antibiotics, a PPI, and bismuth subsalicylate (Pepto-Bismol):
Bismuth: 300 mg by mouth 4 times per day
Metronidazole: 500 mg by mouth 3 times per day
Tetracycline: 500 mg by mouth 4 times per day
PPI (omeprazole): 2 times per day
A variety of antibiotics can treat H. pylori. Most regimens use two together — but some use three. Antibiotic choices include:
Amoxicillin
Clarithromycin
Metronidazole
Tetracycline
Experts say if you’ve ever taken antibiotics in the macrolide or quinolone families, you shouldn’t use clarithromycin or levofloxacin to treat H. pylori. That’s because H. pylori resistance to these antibiotics is very high. As an example, it means if you’ve taken azithromycin (Zithromax or Z-Pak) in the past, you probably need a different regimen.
PPIs are medications that reduce the acid level in the stomach. They play an important part in the treatment of H. pylori because the bacteria doesn’t grow as well in a less acidic environment. Some PPIs include:
Certain PPIs are more powerful and seem to work better for H. pylori treatment — like esomeprazole and rabeprazole. So you may need to take the other PPI options at higher doses or more often to get the best results.
In 2022, the FDA approved a new type of acid-suppressing medication — Vonoprazan. This acid blocker works a little differently than the PPIs listed above. And it appears to be more effective than traditional PPIs when it comes to treating H. pylori infections.
Natural and alternative treatments to get rid of H. pylori are hot topics. From plant polysaccharides (like black currant seeds) to phototherapy, studies are underway on several fronts.
So far, the most promising treatments include:
Probiotics: Foods or supplements with Bifidobacterium, Lactobacillus, or similar probiotic strains may improve the treatment of H. pylori. The “good bacteria” work in several ways to make the stomach and GI tract less hospitable to H. pylori. Studies suggest treatment is more successful when probiotics are used along with standard triple or quadruple therapy.
Smoking cessation: Smoking is linked to H. pylori treatment failure. So quitting is one of the best ways to improve your chances of getting rid of the infection.
Your diet can be another natural treatment for H. pylori. Research does not support diet alone to treat H. pylori. But certain foods have properties and effects that may help, including:
Garlic
Broccoli
Green tea
Honey
Red wine
Licorice
And despite its popularity as a home remedy, there’s no data to support the use of apple cider vinegar in the treatment of H. pylori or acid reflux.
The best ways to prevent H. pylori infection include:
Safe food handling and consumption: Wash your hands before preparing food and eating. Avoid sharing food or utensils with other people — especially if they have known or suspected H. pylori infection.
Healthy immune system: Studies show that eating a variety of healthy foods, getting enough sleep, and exercising regularly help immune function.
Probiotics: Most studies have looked at the use of probiotics to help treat H. pylori. But their positive effects in the GI tract may help prevent H. pylori infections, too.
Scientists are also developing vaccines to prevent H. pylori infections. But these are not ready for prime time yet.
H. pylori is a tough bacteria. It has many characteristics that help it survive in the digestive tract for a long period of time. So it probably won’t go away on its own.
In fact, even with the best treatments, there’s a 10% to 30% failure rate. That’s why the best way to beat this bug is to choose an H. pylori treatment specific to each person’s circumstances.
H. pylori is a stubborn bacteria, so the treatment may feel a bit complex. Successful treatment is increasingly challenging due to antibiotic resistance.
The best strategy to cure the infection is a personalized treatment plan. This should be based on a person’s prior antibiotic usage, medication allergies, and local resistance rates. Cure is most likely when you follow your individualized medication regimen exactly the way it is prescribed.
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