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    Combination Drug Therapy for Peptic Ulcer Disease

    Combination Drug Therapy for Peptic Ulcer Disease


    Combination drug therapy regimens

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

    • A proton pump inhibitor (PPI) plus clarithromycin plus amoxicillin or metronidazole
    • A proton pump inhibitor plus a bismuth compound plus metronidazole plus tetracycline


    Some examples of antibiotics used to treat H. pylori are:

    Generic Name Brand Name
    clarithromycin Biaxin
    metronidazole Flagyl

    Prepackaged drug combinations

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

    Generic Name Brand Name
    bismuth subcitrate potassium and metronidazole and tetracycline Pylera
    bismuth subsalicylate and metronidazole and tetracycline Helidac
    lansoprazole (a PPI) and amoxicillin and clarithromycin Prevpac
    omeprazole (a PPI) and amoxicillin and clarithromycin  

    How It Works

    The right antibiotics combinations usually kill Helicobacter pylori (H. pylori) bacteria that are the cause of many peptic ulcers. At least two antibiotics are used, because combination treatment works better and is less likely to fail because of resistance to the antibiotics.

    Why It Is Used

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

    How Well It Works

    Helicobacter pylori (H. pylori) infections are cured 70% to 85% of the time when the right combination drug treatment is used. footnote 1

    Side Effects

    All medicines have side effects. But many people don't feel the side effects, or they are able to deal with them. Ask your pharmacist about the side effects of each medicine you take. Side effects are also listed in the information that comes with your medicine.

    Here are some important things to think about:

    • Usually the benefits of the medicine are more important than any minor side effects.
    • Side effects may go away after you take the medicine for a while.
    • If side effects still bother you and you wonder if you should keep taking the medicine, call your doctor. He or she may be able to lower your dose or change your medicine. Do not suddenly quit taking your medicine unless your doctor tells you to.

    Call 911 or other emergency services right away if you have:

    • Trouble breathing.
    • Swelling of your face, lips, tongue, or throat.

    Call your doctor if you have:

    • Hives.
    • Bloody, black, or tarry stools.
    • Severe belly pain or nausea.
    • Severe diarrhea.

    Common side effects of this medicine include:

    • Headache.
    • Dark-colored tongue and dark-colored stools caused by bismuth.
    • Mild diarrhea.
    • Mouth sores.
    • Vaginal itching or discharge.

    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 you take all of the medicine prescribed. Do not stop taking your medicine even if you feel better. It may seem like a lot of pills to take, but it is also important to take a regimen that contains at least three medicines to cure Helicobacter pylori (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.

    Completely avoid alcohol use (including nonprescription nighttime cold medicines, such as NyQuil) when you are taking metronidazole. Combining alcohol with this medicine may cause severe nausea and vomiting.

    Tetracycline can make your skin more sensitive to the sun.

    • Stay out of the sun, if possible.
    • Wear long pants, long-sleeved shirts, and hats, if possible.
    • Use sunscreen with an SPF that your doctor recommends.

    Avoid taking milk and other dairy products, antacids, or supplements and vitamins containing iron within 2 hours of taking tetracycline.

    Taking these medicines with a full glass of water can help prevent irritation of the esophagus.

    Taking medicine

    Medicine is one of the many tools your doctor has to treat a health problem. Taking medicine as your doctor suggests will improve your health and may prevent future problems. If you don't take your medicines properly, you may be putting your health (and perhaps your life) at risk.

    There are many reasons why people have trouble taking their medicine. But in most cases, there is something you can do. For suggestions on how to work around common problems, see the topic Taking Medicines as Prescribed.

    Advice for women

    Combinations containing metronidazole or tetracycline

    Do not use this medicine if you are pregnant or planning to get pregnant. If you need to use this medicine, talk to your doctor about how you can prevent pregnancy.

    All other combinations

    If you are pregnant, breast-feeding, or planning to get pregnant, do not use any medicines unless your doctor tells you to. Some medicines can harm your baby. This includes prescription and over-the-counter medicines, vitamins, herbs, and supplements. And make sure that all your doctors know that you are pregnant, breast-feeding, or planning to get pregnant.


    Follow-up care is a key part of your treatment and safety. Be sure to make and go to all appointments, and call your doctor if you are having problems. It's also a good idea to know your test results and keep a list of the medicines you take.

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

    Complete the new medication information form (PDF) (What is a PDF document?) to help you understand this medication.



    1. Chey WD, et al. (2007). American College of Gastroenterology guideline of the management of Helicobacter pylori infection. American Journal of Gastroenterology, 102(8): 1808-1825.

    Other Works Consulted

    • Yang YX, et al. (2006). Long-term proton pump inhibitor therapy and risk of hip fracture. JAMA, 296(24): 2947-2953.


    ByHealthwise Staff
    Primary Medical Reviewer E. Gregory Thompson, MD - Internal Medicine
    Specialist Medical Reviewer Jerome B. Simon, MD, FRCPC, FACP - Gastroenterology

    Current as ofNovember 14, 2014

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