What is the first-line treatment for H. pylori infection?

The first-line treatment for H. pylori infection consists of a combination of two antibiotics and a proton pump inhibitor (PPI). This approach is effective because it simultaneously targets the bacteria with the antibiotics while also reducing gastric acidity with the PPI. By lowering stomach acid, PPIs enhance the effectiveness of antibiotics and promote healing of the gastric mucosa.

Using two antibiotics helps to increase the chances of eradicating the infection due to the potential for antibiotic resistance. This combination can also minimize the risk of treatment failure compared to monotherapy with a single antibiotic. The careful selection of antibiotics and the inclusion of a PPI is based on the organism's characteristics and the role of stomach acid in the infection's persistence.

In contrast, utilizing two antivirals with a PPI is not indicated for H. pylori, as this pathogen is a bacterium and not a virus. Similarly, one antibiotic paired with an antacid does not provide the necessary strength and efficacy for treatment. While employing three antibiotics could theoretically reduce resistance, this is not commonly practiced as a first-line therapy due to concerns about increased side effects and tolerance issues. Thus, the established regimen of two antibiotics and a PPI remains the recommended approach for treating H. pylori.