Table 1: Summary of the main current first- and second-line treatment regimens available for HP eradication.

First-line treatment regimens

Triple standard therapyPPI + CAM + AMPC
and/or MNZ
Eradication of HP infection from 90% to 70–80% Steadily decline in treatment efficacy in USA [7]
Sequential therapyPPI + AMPC for 5 days, then PPI + CAM + MNZ for other 5 days Eradication rates of 90%–94% [8, 9]
Concomitant therapyPPI + CAM + AMPC + MNZ for 7–10 days Eradication rate of 90%. More simple regimen, good alternative to standard triple therapy [10]
Bismuth-based quadruple therapyPPI + Bismuth + Tetracycline + MNZ for 10–14 daysImportant role in countries with high CAM resistance rate; in a recent study patients took PPI and a three-in-one capsule containing bismuth subcitrate potassium, MNZ and Tetracycline with eradication rates of 80% versus 55% in the standard therapy group [11]

Second-line treatment regimens

Levofloxacin-based triple therapyPPI, levofloxacin, and AMPCGood alternative for patients who failed with standard treatment. A recent meta-analysis highlighted that levofloxacin-based triple therapy has lower incidence in side effects than the bismuth-based quadruple therapy, as well as a better eradication rate (87% versus 68%) [12]
Rifabutin-containing rescue therapyWell tolerated, good alternative for patients who failed with a first-line therapy [13]

AMPC: amoxicillin, MNZ: metronidazole, CAM: clarithromycin, and PPI: proton pump inhibitor.