The bacterium Helicobacter pylori (H. pylori) has been implicated in causing ulcer disease (see section on Ulcers and Gastroesophageal Reflux Disease (GERD)). Its presence can be detected by tests of the blood, breath, and stool, as well as through samples taken during endoscopy. When the bacterium, present in a large proportion of people with ulcers, is eradicated, ulcers can heal and the likelihood of recurrence is reduced. Generally, H. pylori is more easily eradicated in duodenal ulcers than in stomach ulcers. If you have H. pylori but do not have an ulcer, there is evidence that H. pylori may protect against the symptoms of gastroesophageal reflux disease (GERD), and you should not take medicine to eradicate the bacterium.
The drugs listed in the table above are either antibiotics or drugs used in combination with antibiotics that have been approved by the Food and Drug Administration (FDA) to treat H. pylori infection. If only one antibiotic is used, resistance is apt to develop and relapse to occur, particularly with metronidazole. Low doses of antibiotics can also lead to resistance. Combining a single antibiotic (amoxicillin or clarithromycin) with a proton pump inhibitor (PPI) still only results in less than 70% of H. pylori being eradicated. The FDA has thus approved a number of regimens that use two antibiotics with a PPI, which allows for shorter periods of therapy (10–14 days). Cure rates of about 80–85% can be expected and recurrence rates are very low. All the PPIs, except pantoprazole (PROTONIX), are approved for use in combination with antibiotics to treat ulcer disease caused by the bacterium Helicobacter pylori. There is no evidence that any one PPI is more effective than another in these combinations.
Another alternative is bismuth, either as bismuth subsalicylate or in ranitidine bismuth citrate. Ranitidine bismuth citrate has been used with clarithromycin and either tetracycline or amoxicillin. Bismuth subsalicylate can be combined with metronidazole and tetracycline for two weeks and a histamine2-blocker for four weeks; this is likely to be the least expensive option. None of the regimens described in this section are approved by the FDA for indigestion or GERD.
The choice of combinations will depend on your allergies, medical condition, other medications you take, antibiotic resistance, and your likelihood of taking several drugs several times a day for up to four weeks. Some drugs must be taken with food, others on an empty stomach. The more drugs you take the more adverse reactions are possible. Prolonged use of antibiotics can cause infections by other organisms. To simplify things, some companies have packaged drugs together in the form of new combination drugs. In this case, you are paying more for convenience, because equivalent drugs are usually available generically. Some are even available without a prescription.