How is H. pylori treated, and how is eradication confirmed?
H. pylori treatment combines acid suppression with selected antibiotics, sometimes with bismuth. The choice depends on resistance, allergies and previous treatment. A test of cure is needed even when symptoms improve.
Details
Why treatment plans differ
A previous antibiotic may be less effective when used again. The 2024 American College of Gastroenterology guideline recommends 14-day bismuth quadruple therapy for many patients when susceptibility is unknown. Your clinician must adapt guideline choices to allergy history, earlier courses and available medicines. This is not a self-treatment prescription.
Plan the follow-up test
A urea breath test or stool antigen test is usually performed at least four weeks after antibiotics. To reduce false-negative results, proton pump inhibitors and related potent acid suppressants are generally withheld for two weeks under medical guidance. Antibiotics and bismuth require a four-week interval before testing. Ask how to manage symptoms during that interval.
If symptoms continue
Persistent discomfort does not by itself establish treatment failure. Blood antibody tests do not reliably confirm eradication. Report missed doses and side effects rather than repeating an old antibiotic course independently.
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