Therapy with two antibiotics in combination with one or two nonantibiotic agents is necessary to eradicate the bacterium. Successful regimens use the antibiotic clarithromycin in combination with either metronidazole or amoxicillin. An example of therapy would be a proton pump inhibitor taken twice a day combined with clarithromycin and amoxicillin both taken twice a day. Therapy in the U.S. is given for two weeks. Resistance to antibiotics is now being seen and is becoming a concern.
Compliance is extremely important for a successful cure.
If a patient being treated for H. pylori had complications from their ulcer, such as bleeding or perforation, then we test to make sure the bacterium has been eradicated after therapy. If the patient had uncomplicated disease, then we monitor for recurrent symptoms rather than performing specific tests to check for eradication. Attempts are being made to develop a vaccine. There is a suggestion that the vaccine may be curative rather than just preventive. These drugs are one of the most used medications in the world today.