Professional and Linguistic Assessments Board (PLAB) Practice Exam

What is the first-line treatment option for H. pylori infection?

1. Clarithromycin

2. Amoxicillin

3. PPI (Proton Pump Inhibitor)

4. All of the above

The correct answer is: All of the above

The first-line treatment for Helicobacter pylori (H. pylori) infection typically involves a combination therapy that includes a proton pump inhibitor (PPI), clarithromycin, and amoxicillin. The rationale for this approach is to ensure effective eradication of the bacterium while promoting healing of the gastric mucosa. A PPI plays a crucial role in reducing gastric acid production, creating a more favorable environment for the antibiotics to work effectively. This reduction in acidity not only enhances the effectiveness of the antibiotics but also promotes better healing of any gastritis or ulcers that may have formed due to the infection. Clarithromycin and amoxicillin are both antibiotics that target H. pylori. They work synergistically within the regimen to combat the infection, with each addressing different aspects of bacterial survival. Clarithromycin disrupts protein synthesis in bacteria, while amoxicillin interferes with bacterial cell wall synthesis. Combining these agents maximizes the chances of eradication and minimizes the risk of developing resistance. Therefore, the correct answer highlights that all listed options—clarithromycin, amoxicillin, and a PPI—are integral components of the recommended first-line treatment regimen for H. pylori infection.