Traditional therapy for H. pylori infection consists of 10 days to 2 weeks of one or two effective antibiotics, such as amoxicillin, tetracycline (not to be used for children <12 yrs.), metronidazole, or clarithromycin, plus either ranitidine bismuth citrate, bismuth subsalicylate, or a proton pump inhibitor. Acid suppression by the H2 blocker or proton pump inhibitor in conjunction with the antibiotics helps alleviate ulcer-related symptoms (i.e., abdominal pain, nausea), helps heal gastric mucosal inflammation, and may enhance efficacy of the antibiotics against H. pylori at the gastric mucosal surface. Currently, eight H. pylori treatment regimens are approved by the Food and Drug Administration (FDA) (Table 1); however, several other combinations have been used successfully. Antibiotic resistance and patient noncompliance are the two major reasons for treatment failure. Eradication rates of the eight FDA-approved regimens range from 61% to 94% depending on the regimen used. Overall, triple therapy regimens have shown better eradication rates than dual therapy. Longer length of treatment (14 days versus 10 days) results in better eradication rates.
Many natural remedies have also been suggested and have shown to have efficacy. For example, a Japanese study in April 2009 found that broccoli is an effective natural remedy of the H. pylori bacteria. It is thought that sulforphanes found in broccoli sprouts have antimicrobial properties. In 1998, an Israeli study found that extracts of cinnamon inhibited urease enzymes from catalyzing reactions in H. pylori cells. There are several other substances that have been offered to counteract H. pylori including herbs like garlic and ginger, oils such as coconut and oregano oil and apple cider vinegar.