Background: Helicobacter pylori (H. pylori) infection is the most common cause of
peptic ulcer disease and it can be associated with many complications, including malignancies. In
clinical practice, some clinicians may use Clavulanic Acid (CA) in combination with amoxicillin or
other beta-lactams as an addition to the standard treatment regimens. This practice may be done by
habitual mistake, non-evidence based hypothetical assumptions, or by prescribing it as an alternative
treatment. This review aims to expose the effect of CA against H. pylori infection and to review
the possible mechanisms that may contribute to that effect.
Methods: A PubMed and Google Scholar literature search was obtained on both pre-clinical and
clinical studies related to CA and H. pylori infection.
Results: Available clinical studies showed improvement in the eradication of H. pylori by about 10-
20% when CA was added to the treatment regimens. This effect for CA could be related to several
mechanisms including inhibition of H. pylori growth by binding to Penicillin-Binding Proteins
(PBPs), the transformation of H. pylori from the active filamentous form into coccoidal form, induction
of the release of dopamine, modulation of immunological response towards H. pylori infection
and its relationship with other microbiota. Randomized-controlled studies on patients with
resistance to H. pylori are needed. Moreover, in vitro studies to evaluate the mechanisms by which
CA may influence H. pylori are warranted.
Conclusion: The presented literature suggests potential avenues for the use of CA in the management
of peptic ulcer disease and H. pylori infection.