Weight-Adjusted Therapy Boosts H. pylori Eradication Rates in Obese Patients

Obesity may compromise the effectiveness of standard H. pylori treatment—but adjusting antibiotic doses to body weight could change that.

In a multicenter cohort study evaluating 228 obese patients undergoing bariatric surgery, researchers found that weight-adjusted quadruple therapy significantly outperformed the traditional fixed-dose regimen in eradicating H. pylori infection. All patients received 14-day concomitant quadruple therapy, but were divided into 3 groups based on antibiotic dosing strategy.

Patients on fixed doses (Group 1) had a 68% eradication rate, while those receiving weight-adjusted higher doses of amoxicillin and metronidazole (Group 2) achieved an 86% success rate. Patients dosed according to the adjusted body weight formula (Group 3) had the highest eradication rate at 89.5%. The improvement in eradication rates between Group 1 and the weight-adjusted groups was statistically significant (p < 0.05), with odds ratios of 0.34 and 0.25, respectively.

While adverse event rates were somewhat higher in the weight-adjusted groups—particularly in Group 2 (27.4%)—the differences were not statistically significant. The study also found no significant variation in baseline characteristics such as age, gender, smoking, or diabetes across the groups.

These findings suggest that subtherapeutic dosing in obese patients may be a key driver of treatment failure in H. pylori infections. As obesity remains prevalent globally, particularly in Western countries, the authors advocate for individualized antibiotic dosing strategies to maximize therapeutic outcomes and reduce eradication failures.