Combination drug therapy for peptic ulcer disease

Examples

Combination drug therapy to treat a peptic ulcer caused by Helicobacter pylori (H. pylori) infection involves taking two antibiotics, a proton pump inhibitor, and sometimes a bismuth-containing medication.

Antibiotics

You will need two of the following antibiotics to treat your infection.¹ It is important that the right combination of antibiotics that will kill the infection be selected. If the antibiotics are not effective, the bacteria may become resistant to the action of some antibiotics, making the infection harder to eliminate.

Generic Name	Brand Name
amoxicillin	Amoxil
clarithromycin	Biaxin
metronidazole	Flagyl
tetracycline hydrochloride	Achromycin

Combination drug therapy regimens

Combination drug therapy regimens commonly used to treat an H. pylori infection include the following options:¹

• A proton pump inhibitor (PPI) plus clarithromycin plus amoxicillin or metronidazole for 1 to 2 weeks
• A proton pump inhibitor plus a bismuth compound plus metronidazole plus tetracycline for 1 to 2 weeks
• Ranitidine hydrochloride plus a bismuth compound plus either clarithromycin, metronidazole, or tetracycline hydrochloride

Prepackaged drug combinations

Some of the recommended drug combinations are packaged together for convenience:

Generic Name	Brand Name
bismuth subsalicylate and metronidazole and tetracycline hydrochloride	Helidac
lansoprazole and amoxicillin and clarithromycin	Prevpac

How It Works

Antibiotics kill the H. pylori bacteria that are the cause of most peptic ulcers. To reduce the risk that H. pylori will be resistant to the antibiotics used to kill them, more than one antibiotic is used at the same time.

Why It Is Used

Combination drug therapy that includes at least two antibiotics, an acid reducer (which may include a proton pump inhibitor), and sometimes a bismuth compound is recommended for people who have peptic ulcer disease and are known to be infected with H. pylori.

How Well It Works

H. pylori infections are cured 80% to 90% of the time when an appropriate combination drug therapy regimen is used.^{1, 2}

Side Effects

The side effects of antibiotics may include:

• Abdominal cramps.
• Nausea and vomiting.
• Diarrhea.
• Skin rash.
• Allergic reaction.

See Drug Reference for a full list of side effects. (Drug Reference is not available in all systems.)

What To Think About

It is very important that people who are being treated for an H. pylori infection take all of the medications prescribed. It is also important to take a regimen that contains at least three medications to cure H. pylori. Combination regimens are the most effective way to help ensure that H. pylori bacteria do not develop resistance to the antibiotics used to treat them.

If an H. pylori infection is not cured after appropriate treatment, you will need to take a different antibiotic.

Some people who have been treated for H. pylori infection need follow-up testing to ensure that the infection is cured.¹

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Author:	Colleen Cronin Ralph Poore	Last Updated January 12, 2006
Medical Review:	Kathleen Romito, MD - Family Medicine Andrew H. Soll, MD - Gastroenterology
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