H. Pylori Treatments: Antibiotics, PPI Medications, and More

Helicobacter pylori — better known as H. pylori — is a bacteria that infects the stomach and digestive tracts of 1 in 3 adults in the U.S.

For some people, H. pylori causes gastritis (inflammation of the stomach lining) or painful stomach or duodenal ulcers. H. pylori infection also increases the risk of developing stomach cancer (gastric cancer). 

H. pylori treatment can relieve symptoms and lower your future risk of stomach cancer. In this article, we’ll review the most up-to-date treatment recommendations for H. pylori infection.

What’s included in H. pylori treatment?

Unlike some infections, H. pylori infections usually can't be treated with just one antibiotic. Instead, you'll need a combination of medications that work together to get rid of the bacteria. Treatment usually includes:

• Antibiotics: You’ll take 2 or more antibiotics to kill the bacteria. Because H. pylori is resistant to some antibiotics, the antibiotics you need may change if the first treatment doesn't work.

• Acid-lowering medications: These medications lower the amount of acid in your stomach. This helps the antibiotics work better and gives your stomach time to heal. There are 2 types of acid-lowering medications that help treat H. pylori: proton pump inhibitors (PPIs) and potassium competitive acid blockers (PCABs).

• Bismuth salts: This medication helps kill H. pylori, protects the lining of your stomach, and can help antibiotics work better. Unlike antibiotics, H. pylori hasn't become resistant to bismuth.

Below, we’ll look at the most common combinations of the medications used to treat H. pylori.

1. Bismuth quadruple therapy

Bismuth quadruple therapy (BQT) is the preferred first treatment for most people with H. pylori infection. It’s also an option for people who tried an older treatment called triple therapy and need a second course of treatment. BQT is also the best choice for people who are allergic to penicillin.

You'll take these 4 medications for 14 days. This treatment gets rid of H. pylori in about 9 in 10 people when taken as directed.

Bismuth quadruple therapy includes:

• A PPI 2 times a day

• Bismuth salts 4 times a day

• Tetracycline — an antibiotic — 4 times a day

• Metronidazole (Flagyl) — an antibiotic — 3 or 4 times a day

Often, BQT requires more than one prescription. One common regimen includes: 

• Pylera (bismuth subcitrate / metronidazole / tetracycline) 4 times a day 

• Omeprazole (Prilosec) twice a day for 10 days 

These medications can also be prescribed separately as lower-cost generics.

2. Rifabutin triple therapy

Rifabutin triple therapy is another treatment option. It can be used as a first-choice treatment for H. pylori. But it’s more commonly used when BQT doesn’t get rid of the infection and people need a second treatment. 

Rifabutin triple therapy includes: 

• Omeprazole (a PPI)

• Amoxicillin, an antibiotic

• Rifabutin (Rifadin), an antibiotic

These medications can be prescribed separately as lower-cost generics. But they’re also available in a combination pill called Talicia (omeprazole / amoxicillin / rifabutin). Talicia is FDA approved to treat H. pylori infection The usual dosage is 4 capsules, 3 times a day for 14 days. Studies found that Talicia cured H. pylori in about 84% of people after 2 weeks of treatment.

3. PCAB dual therapy

Potassium channel acid blocker (PCAB) dual therapy is used when BQT isn't a good choice. This treatment includes:

• Vonoprazan (Voquezna), a PCAB

• Amoxicillin, an antibiotic

These medications are available separately. They also come together as Voquezna Dual Pak. Voquezna Dual Pak includes daily blister packs labeled with morning, afternoon, and evening doses, making it easier to remember when to take each pill. 

You'll take these medications up to 3 times a day for 14 days. In clinical trials, Voquezna Dual Pak got rid of H. pylori in about 78% of people. But some studies suggest it may work as well as BQT.

Voquezna Dual Pak can be a good choice for some people because it has fewer pills than other H. pylori treatments. It also doesn't contain bismuth, so you can avoid side effects such black stools or a metallic taste.

4. PCAB triple therapy

Potassium channel acid blocker (PCAB) triple therapy is recommended if testing shows that your H. pylori infection is sensitive to the antibiotic clarithromycin (Biaxin). It can be used as a first-choice treatment or when other treatments haven’t worked.

In these cases, it may work better than Voquezna Dual Pak and may work as well as BQT.

This treatment includes:

• Vonoprazan, a PCAB

• Amoxicillin, an antibiotic

• Clarithromycin, an antibiotic

These medications are available separately. They also come together as Voquezna Triple Pak. You'll take these medications twice a day for 14 days. Each daily blister pack is labeled with morning and evening doses to help you stay on schedule.

Like Voquezna Dual Pak, the Triple Pak doesn't contain bismuth, so you can avoid side effects like black stools and a metallic taste. Because it has fewer pills than BQT, it may be easier for some people to take.

Natural treatment for H. pylori

Natural remedies can’t cure an H. pylori infection or replace the prescription treatments covered above. But these options may help support your recovery:

• Probiotics: These may help your treatment work better and may reduce antibiotic side effects.

• Quitting smoking: Smoking increases inflammation, making it harder for your body to heal.

• Cranberry: Research suggests cranberry may help standard H. pylori treatments work better. But it’s not clear how much people need to consume for this effect. 

What to expect during and after the H. pylori treatment

H. pylori treatment can be hard to stick with because you'll need to take several medications multiple times a day. To give the treatment the best chance of working, aim to do the following:

• Take every dose, even if you start feeling better.

• Eat small, frequent meals if your stomach feels upset.

• Avoid alcohol, smoking, and nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Advil, Motrin), which can irritate your stomach.

The medications used to treat H. pylori can cause different side effects. Most are mild and go away after treatment ends. Common side effects include:

• Bismuth: black stools, a dark tongue, and a metallic taste

• Metronidazole: nausea, diarrhea, stomach pain, and a metallic taste

• Tetracycline: nausea and increased sensitivity to the sun

• PPIs: headache and diarrhea

Most people start to feel better within a few days to a couple of weeks after finishing H. pylori treatment. Stomach pain, bloating, and indigestion should gradually improve. 

A healthcare professional will typically order a follow-up test to make sure the H. pylori infection is gone. If the infection is still there, you'll likely need another round of treatment using a different combination of medications.

How to prevent H. pylori

There are ways to lower your risk of H. pylori infection. Some things you can do include:

• Practice 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 a known or suspected H. pylori infection.

• Support your immune system: Eating a variety of nutrient-rich foods, getting enough sleep, and exercising regularly help keep your immune system healthy. 

• Probiotics: Most studies have looked at the use of probiotics to help treat H. pylori. But their positive effects in the gastrointestinal (GI) tract may help prevent H. pylori infections too. 

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Written by:

Patricia Pinto-Garcia, MD, MPH

Patricia Pinto-Garcia, MD, MPH, is a medical editor at GoodRx. She is a licensed, board-certified pediatrician with more than a decade of experience in academic medicine.

Reviewed by:

Stacia Woodcock, PharmD

Stacia Woodcock, PharmD, is a pharmacy editor for GoodRx. She earned her Doctor of Pharmacy degree from the University of Kentucky and is licensed in New York and Massachusetts.

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