For a patient with a duodenal ulcer and a positive rapid urease test for H. pylori, what is the most appropriate initial treatment?

Starting omeprazole (Prilosec) along with antibiotic therapy against H. pylori is the most appropriate initial treatment for a patient with a duodenal ulcer and a positive rapid urease test for H. pylori. This approach is based on the understanding that H. pylori infection is a significant contributing factor to the development of peptic ulcers, and successful eradication of the bacteria is essential in promoting healing and preventing recurrence.

Omeprazole, a proton pump inhibitor, decreases gastric acid secretion, which helps to reduce ulcer-related pain and facilitates the healing of the ulcer by creating a less acidic environment. Combining this with antibiotics that are effective against H. pylori, such as amoxicillin or clarithromycin, ensures that the infection can be treated effectively.

This approach aligns with established treatment guidelines for peptic ulcer disease caused by H. pylori, which emphasize the use of a "triple therapy" regimen that includes a proton pump inhibitor and two antibiotics. This dual action not only addresses the ulcer but also targets the underlying infection, significantly improving patient outcomes.

Other options, such as using antacids or planning surgical interventions, would not be appropriate as initial treatments. Antacids may provide temporary relief but do