Final answer:
The management of persistent H. pylori infection involves triple therapy with a combination of two antibiotics and a medication to decrease stomach acid for a duration of 10 to 14 days, although resistance to antibiotics can result in treatment failure.
Step-by-step explanation:
The management of persistent H. pylori infection involves a combination of antibiotics and medications that decrease stomach acid levels. The standard treatment recommended by the US Food and Drug Administration includes a triple therapy approach. These therapies can consist of a 10-day treatment with the combination of omeprazole, amoxicillin, and clarithromycin (OAC); a 14-day treatment with bismuth subsalicylate, metronidazole, and tetracycline (BMT); or a 10 or 14-day treatment with lansoprazole, amoxicillin, and clarithromycin (LAC). In these protocols, omeprazole, bismuth subsalicylate, and lansoprazole are used to reduce gastric acidity as H. pylori thrives in acidic environments. Unfortunately, due to the development of antibiotic resistance by H. pylori, these treatments are not always effective, and sometimes, if a peptic ulcer has become too severe, emergency surgery is required.