Table 4.

Methods to enhance the effectiveness of H. pylori therapy

Take a detailed medical and antibiotic use history and provide adequate time for office visits.

Explain in simplistic terms the effects of the infection on the stomach, the potential outcomes of the infection, and how cure of the infection results in healing of the damage, prevention of ulcers and ulcer recurrences, and greatly reducing the risk of gastric cancer.

Provide a clear written description of the complexities of the regimen chosen and the necessity for adherence to the full treatment schedule

Provide a clear written description of the medications and plan for dosing and, if possible, providing appropriate containers (pill boxes or blister packs) arranged according to the dosing plans in relation to meals and bedtime.

Emphasize that the medications are taken concurrently for the full 14-day period and to not start to take the medications until all of the drugs have been received.

Describe the adverse effects which are commonly expected as a consequence of the treatment, such as feeling unwell with nausea, headaches, taste disturbances, loose or dark stool. etc..

Provide written instructions in a language that can be read and understood for patients where English is not their first language.

To ensure adherence, provide a contact available after hours and weekends that can answer questions.

Monitor adherence by discussion and by pill counting during treatment if necessary.

A test-of-cure by breath or stool antigen /PCR test should be done 4 or more weeks after therapy and off PPIs for at least 2 weeks to ensure cure and provide feedback on the local effectiveness of the therapy utilized. H2 receptor antagonists can be substituted during the PPI abstinence period.

Test-of-cure results should be shared with colleagues and institutions locally to provide information regarding local susceptibility patterns.

Adapted from reference (13), with permission