Medications

For people whose peptic ulcer is caused by nonsteroidal anti-inflammatory drugs, or NSAIDs, with or without an H. pylori infection, providers may recommend a variety of medications.

Proton Pump Inhibitors (PPIs)
PPIs reduce stomach acid and protect the lining of the stomach and duodenum. While PPIs can't kill H. pylori, they do help create a lower-acid environment so antibiotics can work effectively to fight the infection.

Histamine-2 (H2) Blockers
H2 blockers work by blocking histamine, a chemical in the body that signals the stomach to produce acid.

Protectants
Protectants coat ulcers and protect them against acid and enzymes so that healing can occur.

Antibiotics
Antibiotics can kill H. pylori bacteria.

Bismuth Subsalicylates
Medicines containing bismuth subsalicylate coat a peptic ulcer, protect it from stomach acid, and provide antibiotic effects that kill H. pylori.

Antacids
An antacid may temporarily relieve pain from a peptic ulcer, but it cannot kill H. pylori. Some antibiotics may not work as well in combination with certain types of antacids.

For people whose peptic ulcer is caused by H. pylori, providers may prescribe triple therapy, quadruple therapy, or sequential therapy, which are different names for varying combinations of antibiotics and acid-suppressing medicines.

Triple Therapy
Triple therapy includes a seven- to 14-day regimen of two kinds of antibiotics and a PPI. The first antibiotic is clarithromycin, and the second is either metronidazole or amoxicillin.

Quadruple Therapy
Quadruple therapy includes a 14-day regimen of a PPI, bismuth subsalicylate, and two antibiotics: tetracycline and metronidazole. Quadruple therapy may be prescribed for any patients who can't take amoxicillin because of a penicillin allergy, or patients who have previously received a macrolide antibiotic, such as clarithromycin.

Sequential Therapy
In sequential therapy, treatment starts with a PPI and amoxicillin for five days. For the next five days, a PPI, clarithromycin, and the antibiotic tinidazole are prescribed.

Triple therapy, quadruple therapy, and sequential therapy may cause nausea and other side effects, depending on the medications selected, including:

  • An altered sense of taste
  • Darkened stools
  • A darkened tongue
  • Diarrhea
  • Headaches
  • Temporary reddening of the skin when drinking alcohol
  • Vaginal yeast infections in women