Helicobacterpylori Eradication Therapies in the Era of Increasing Antibiotic Resistance: A Paradigm Shift to Improved Efficacy
Table 1
Recommended regimens for Helicobacter pylori therapy.
Treatment
Regimen
First-line treatments
Sequential therapy
A 5 d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 5 d triple therapy with a PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), and metronidazole (500 mg, b.i.d.)
Concomitant therapy
A 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 d
Hybrid therapy
A 7 d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 7 d 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.)
Bismuth-containing quadruple therapy
A PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.), tetracycline (500 mg, q.i.d.), and metronidazole (500 mg, t.i.d.) for 10–14 d
Second-line/Salvage treatments
Levofloxacin-based triple therapy
A PPI (standard dose, b.i.d.), levofloxacin (500 mg, b.i.d.), and amoxicillin (1 g, b.i.d.) for 10 d
Bismuth-containing quadruple therapy
A PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.), tetracycline (500 mg, q.i.d.), and metronidazole (500 mg, t.i.d.) for 14 d
Standard triple therapy*
A PPI (standard dose, b.i.d.), amoxicillin (1 g, b.i.d.), and clarithromycin (500 mg, b.i.d.) for 14 days
Levofloxacin-based sequential therapy**
A 5 d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 5 d triple therapy with a PPI (standard dose, b.i.d.), levofloxacin (250 mg, b.i.d.), and amoxicillin (1 g, b.i.d.)
Amoxicillin-based dual therapy (high dose)
A PPI (high dose, t.i.d) and Amoxicillin (1 g, t.i.d.) for 14 days
Rifabutin-based triple therapy
A PPI (standard dose, b.i.d.), rifabutin (150 mg b.i.d.), and amoxicillin (1 g b.i.d.) for 14 d
Furazolidone-based quadruple therapy
A PPI (standard dose, b.i.d.), tripotassium dicitratobismuthate (240 mg, b.i.d.), furazolidone (200 mg, b.i.d.), and tetracycline (1 g, b.i.d.)
*Employed after antibiotic susceptibility testing; **regimen under evaluation; regimen usually employed as third-line therapy; PPI: proton pump inhibitor.
