What is the first-line treatment for active ulcer disease caused by Helicobacter pylori?

The first-line treatment for active ulcer disease caused by Helicobacter pylori is a regimen known as triple therapy, which typically includes a proton pump inhibitor (PPI), amoxicillin, and clarithromycin. This approach is effective because the proton pump inhibitor reduces gastric acidity, enhancing the antibiotic effectiveness against H. pylori, as the bacteria thrive in less acidic environments. Amoxicillin and clarithromycin provide broad-spectrum coverage against the bacteria, leading to higher eradication rates.

This combination has been widely studied and recommended due to its successful outcomes in clinical practice, as it targets the bacteria directly while also promoting healing of the gastric lining by reducing acidity.

Other options lack the appropriate combination or effectiveness. For example, single therapy with metronidazole does not provide a sufficient two-antibiotic approach necessary for effective eradication of H. pylori. Quadruple therapy with bismuth subsalicylate, while useful in certain cases, is generally considered when first-line treatment fails or for specific patient populations. The two-antibiotic regimen with amoxicillin and tetracycline is also not considered first-line therapy due to the lack of an acid-reducing agent, which is essential for optimal treatment.