Treatment of Helicobacter pylori in Special Patient Populations

Pharmacotherapy. 2019 Oct;39(10):1012-1022. doi: 10.1002/phar.2318. Epub 2019 Sep 2.


Helicobacter pylori infection can lead to gastritis, gastric and duodenal ulcers, and gastric cancer. Consequently, complete eradication is the goal of therapy. First-line therapy for H. pylori infection includes clarithromycin triple therapy (clarithromycin, proton pump inhibitor [PPI], and amoxicillin or metronidazole), bismuth quadruple therapy (bismuth salt, PPI, tetracycline, and metronidazole or amoxicillin), or concomitant therapy (clarithromycin, PPI, amoxicillin, and metronidazole). However, many patients have relative contraindications to the antibiotics included in these regimens, making therapy selection difficult. Furthermore, failure of initial therapy makes selection of second-line therapy challenging due to concerns for potential resistance to agents included in the initial regimen. This review discusses H. pylori microbiology, including antibiotic resistance, and summarizes the existing evidence for first- and second-line treatment regimens that may be considered for special populations such as patients with penicillin allergies, patients with or at risk for QTc-interval prolongation, and patients who are pregnant, breastfeeding, or elderly.

Keywords: Helicobacter pylori; QT prolongation; breastfeeding; elderly; hypersensitivity; pregnancy.

Publication types

  • Review

MeSH terms

  • Antacids / pharmacology*
  • Anti-Bacterial Agents* / classification
  • Anti-Bacterial Agents* / pharmacology
  • Drug Therapy, Combination / methods
  • Helicobacter Infections / drug therapy*
  • Helicobacter Infections / microbiology
  • Helicobacter pylori* / drug effects
  • Helicobacter pylori* / isolation & purification
  • Humans
  • Patient Selection
  • Practice Guidelines as Topic
  • Proton Pump Inhibitors / pharmacology*


  • Antacids
  • Anti-Bacterial Agents
  • Proton Pump Inhibitors