Pharmacologic aspects of eradication therapy for Helicobacter pylori Infection

Gastroenterol Clin North Am. 2010 Sep;39(3):465-80. doi: 10.1016/j.gtc.2010.08.007.


The commonly used regimens for the eradication of Helicobacter pylori infection consist of administration of proton pump inhibitors (PPIs) and 1 to 3 antimicrobial agents, such as amoxicillin, clarithromycin, metronidazole, fluoroquinolone, or tetracycline. Each agent has its own pharmacologic characteristics. PPIs are metabolized by cytochrome P450 2C19 (CYP2C19), which is polymorphic. CYP2C19 genotypic differences in the pharmacokinetics and pharmacodynamics of PPIs influence the eradication rates of H pylori infection by PPI-containing regimens. Amoxicillin is a time-dependent antibiotic, whereas clarithromycin, metronidazole, tetracycline, and fluoroquinolone are not. The plasma half-life of antimicrobial agents also differs among these antibiotics. To achieve consistently high eradication rates, the eradication regimens must be designed based on a good understanding of the resistance patterns of the bacteria and the pharmacologic characteristics of the agents used for H pylori eradication therapy.

Publication types

  • Research Support, N.I.H., Extramural
  • Research Support, U.S. Gov't, Non-P.H.S.
  • Review

MeSH terms

  • Anti-Bacterial Agents / pharmacology*
  • Anti-Bacterial Agents / therapeutic use
  • Drug Therapy, Combination
  • Gastrointestinal Diseases / drug therapy*
  • Gastrointestinal Diseases / microbiology
  • Gastrointestinal Diseases / prevention & control*
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / prevention & control*
  • Helicobacter pylori*
  • Humans
  • Pharmacogenetics
  • Proton Pump Inhibitors / pharmacology*
  • Proton Pump Inhibitors / therapeutic use
  • Upper Gastrointestinal Tract / microbiology
  • Upper Gastrointestinal Tract / pathology


  • Anti-Bacterial Agents
  • Proton Pump Inhibitors