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Helicobacter pylori is the bacterium responsible for most cases of chronic gastritis, peptic ulcers, and stomach cancer.  Antibiotic therapy is always employed for treatment of infection with this organism, but the protocol most physicians follow has become increasingly ineffective.

The antibiotics generally prescibed are clarithromycin plus either amoxicillin or an imidazole, given usually with a proton pump inhibitor to block stomach acid release and raise their efficacy.  However this regimen is ineffective in nearly 25% of cases, due to antibiotic resistance.

A newer and slightly more complicated regimen is considerably more effective.  It reduces the failure rate by half.  First the patient receives 5 days of treatment with amoxicillin plus the proton pump inhibitor.  Then two other antibiotics are given for an additional 5 days, usually clarithromycin and an imidazole, plus the proton pump inhibitor.

Success can be assessed using the urea breath test or stool antigen test for H. pylori, 6 weeks after the treatment is completed.

Allan Sosin, M.D.

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