Table 1: Recommended first-line therapies for Helicobacter pylori infection.

TreatmentRegimenHigh clarithromycin resistance areaLow clarithromycin resistance area

Standard triple therapyA PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), and amoxicillin (1 g, b.i.d.) for 7–14 daysxV

Bismuth-containing quadruple therapyA PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.), tetracycline (500 mg, q.i.d.), and metronidazole (250 mg, q.i.d.) for 10–14 daysVV

Sequential therapyA 5-day dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 5-day triple therapy with a PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.)VV

Concomitant therapyA PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), amoxicillin (1 g, b.i.d.), and metronidazole (500 mg, b.i.d.) for 7–10 daysVV

Levofloxacin-based triple therapyA PPI (standard dose, b.i.d.), levofloxacin (500 mg, q.d.), and amoxicillin (1 g, b.i.d.) for 10 daysV*

Hybrid therapyA 7-day dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 7-day quadruple therapy with a PPI (standard dose, b.i.d.), amoxicillin (1 g, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.)VV

-based triple therapy is useful, but it might not be recommended as first-line therapy under the consideration of rapidly increasing resistance.