Intravenous Antibiotic for H Pylori Infection

• All available guidelines ONLY recommend oral therapy for H Pylori eradication
• Antimicrobial treatment of H.pylori is difficult, as the bacteria are located below the mucus layer, adherent to gastric mucosa where the access of antimicrobial drugs, given either by enteral or parenteral route is limited

Evidences Supporting for IV Regimes

Intravenous 3-day Helicobacter pylori eradication therapy is highly effective in patients with bleeding peptic ulcer.  Gastroenterol Hepatol. 2002 Jun-Jul;25(6):383-6.

• intravenous pantoprazole (40 mg/12 hours), metronidazole (500 mg/8 hours) and amoxicillin-clavulanic acid (1,000 mg/200 mg/8 hours) was administered for 72 hours
• ultra-short course eradication therapy used in this study is highly effective. Its efficacy is similar to that of oral treatment and it avoids certain problems such as adverse effects and adherence to treatment

M. Amini and A. Tajik, 2009. Oral and Intravenous Eradication of Helicobacter pylori. Pakistan Journal of Biological Sciences, 12: 809-812

• Amine et al. concluded that both five-day intravenous (metronidazole, ampicillin, ranitidine and orally administered bismuth) therapeutic regimen in patients with active gastric bleeding and 14-day oral regimen (metronidazole, amoxicillin, ranitidine and bismuth sub-citrate) in patients without active gastric bleeding would have good efficacy and low rate of drug adverse events

Evidences against IV Regimens

Three-day intravenous triple therapy is not effective for the eradication of Helicobacter pylori infection in patients with bleeding gastro-duodenal ulcer. Aliment Pharmacol Ther 2003; 18: 1023–1029

• An ultra-short, 3-day, intravenous, triple therapy containing omeprazole, clarithromycin and amoxicillin–clavulanic acid cannot be recommended as an effective eradication regimen for H. pylori infection related to haemorrhagic gastro-duodenal ulcer

A three-day course of intravenous omeprazole plus antibiotics for H. pylori-positive bleeding duodenal ulcer. Hepatogastroenterology. 1999 Jul-Aug;46(28):2363-71.

• 3-day intravenous regimens ( intravenous omeprazole (80 mg loading then 40 mg q 9 am & 9 pm) plus ampicillin/salbactum (1.5 gm i.v. loading then 750 mg q 9 am, 3 pm, & 9 pm)  may achieve clearance of H. pylori quickly.
• However, they were not so effective for eradication, especially in cases with higher bacterial loads

References:

1.                   www.uptodate.com

2.                   Helicobacter Pylori Infection : Current Status.

3.                   http://medind.nic.in/jac/t00/i2/jact00i2p148.pdf

4.                   https://www.ncbi.nlm.nih.gov/pubmed/12069699

5.                   https://www.ncbi.nlm.nih.gov/pubmed/19806813