Helicobacter pylori eradication

Therapy Helicobacter pylori / eradication

Before it was known that Helicobacter pylori Caused stomach inflammation, Helicobacter pylori infection was treated with medicines that neutralize stomach acid (Antacids) and gastric acid inhibitors (Proton pump inhibitors).

The current therapy for Helicobacter pylori infection requires proof of the germ and includes treatment / eradication with three to be taken at the same time Medication. Be combined two antibiotics and a proton pump inhibitor, which prevents gastric acid release and thus Helicobacter pylori im survival stomach made considerably more difficult. This is necessary to fight the germ and not just, as in the past, to treat the symptoms.

The revised in 2005 Maastricht consensus criteria write the indications for elimination (Eradication) of the germ in a Helicobacter pylori infection.

Secure and recommended indications are differentiated here. Confirmed indications are a stomach or duodenal ulcer, an atrophic gastritis or a MALT lymphoma.

Helicobacter pylori infected patients with partial removal of the stomach (partial resection) because of a Gastric cancer or a peptic Gastric ulcer (Ulcer) and patients who have a first-degree relative a Stomach cancer has developed, it is suggested to perform a Helicobacter pylori eradication with the antibiotic treatment for eradication described above.
In contrast, there are advisable indications such as functional dyspepsia, gastrooesophageal Reflux disease and the longer intake nonsteroidal anti-inflammatory drugs, such as Diclofenac or Ibuprofen.
Eradication with just one Antibiotic (Monotherapy) does not achieve sufficient success in combating the germ.
The Triple therapy however, in almost all cases it leads to the eradication (extinction / destruction) of the germ.

There are different schedules according to which the medication is administered. What they all have in common is a seven-day application of 3 capsules in the morning and in the evening.

  • Amoxicillin or Metronidazole
  • Clarithromycin.

The French triple therapy of eradication consists of:

  • the proton pump inhibitor Pantoprazole in combination
  • with the antibiotics Amoxicillin
  • and Clarithromycin.

The treatment usually responds well and the eradication rate is high. In the Italian triple therapy, the difference is in the administration of Metronidazole (Clont®) instead of Amoxicillin. Since amoxicillin is a penicillin-Antibiotic and up to 10% of the population have a penicillin- allergy Italian therapy is desirable for those affected. However, there are Helicobacter pylori strains that are resistant to metronidazole. In the English therapy, which combines metronidazole and amoxicillin as antibiotics, germs are only eliminated in about 70-80%. Further possible combinations are being tested and in some studies have already achieved even better eradication results than the previous ones. However, in order to be able to recommend this as a primary therapy option, further experience reports must be awaited.

In the event of a failed eradication you have to cultivate the pathogen and exclude resistance to antibiotics.

In the event of failure of the triple therapy due to the lack of cultivation of the germ, there is the possibility of a Quadruple Treatment. This involves combining a proton pump inhibitor with the antibiotics Tetracycline and Metronidazole, as well as a Bismuth salt over a period of ten days.
More antibiotics like Rifabutin or Levofloxacin can alternatively also be given over a period of time that is sometimes longer. These rescue treatments (= rescue therapy) are exceptions and are mainly recommended for patients who have failed standard triplicate therapy or who are resistant to antibiotics.


Guidelines for the attending physician

There are guidelines for Helicobacter pylori eradication that are based on the recommendations of the Working Group of Scientific Medical Societies (AWMF) are based. Such guidelines exist for the diagnosis and treatment of many diseases. They serve as a guide for doctors, but are not legally binding. They are based on the results of scientific studies and should ensure more safety in medicine, but also take economic aspects into account.

The guidelines for Helicobacter pylori eradication are an updated version of the recommendations published by the German Society for Digestive and Metabolic Diseases (DGVS) were issued in 1996. The current guidelines were agreed upon by the German Society for Hygiene and Microbiology, the Society for Pediatric Gastroenterology and Nutrition and the German Society for Rheumatology.

On the one hand, the guidelines state which tests can be used to make a reliable diagnosis. For example, the urease rapid test, culture of the bacterium and microscopic detection are recommended. The urea breath test, the detection of antigens in the stool or antibodies in the blood are also possible tests.

On the other hand, the guidelines for Helicobacter pylori eradication contain the findings that must be available in a patient in order to carry out an eradication as a recommended therapy. These include B. a stomach ulcer (peptic gastric ulcer), the asymptomatic Helicobacter pylori gastritis and stomach cancer (Gastric cancer).

Depending on the severity of the disease, the guidelines can be used to find out whether or not eradication is recommended and which requirements should be met for this, i.e. which test results should be available in order to initiate therapy.

The recommendations for the drugs that are recommended can also be found in the guidelines. It also includes suggestions for second-line therapy, which is started when first-line therapy is not effective or when patients cannot tolerate it.

It is also recommended that a review of the success of the eradication should be performed and that this should take place at least four weeks after the end of antibiotic therapy.


The dosage of eradication therapy is the same for all three therapy schemes. It should be the prescribed medication taken in the morning and in the evening become. The guidelines recommend the medication in each case before the meal to take. Depending on the therapy scheme, different active ingredients are used in the therapy. However, they all have in common that one tablet should be taken in the evening and in the morning. This dosage of one tablet in the morning and in the evening does not change in the second-line therapy either.

Side effects

Eradication therapy involves many Antibioticswhich often lead to undesirable side effects, especially in the gastrointestinal tract. According to guidelines, the rate of patients with side effects is around 10-15%. Most of the time, these side effects are Diarrheadue to the antibiotics. Occasionally, however, can also Nausea, taste disturbance, headache and Skin irritation occur.

In addition, the administration of many antibiotics can lead to the Bacteria resistance develop. This means that they can change in such a way that they can no longer be rendered harmless by the antibiotic. These resistances can be passed on so that the bacteria will become resistant to many different antibiotics over the course of many years. This would have dire consequences, as over time the effective antibiotics would run out and effective therapy could no longer be carried out. To prevent this, you can use the Test bacteria before therapy and thus determine whether or not they are resistant to it.

Please also read our article on this Antibiotic side effects