Table 1.

Recommended treatment regimens for Helicobacter pylori eradication

Treatment	Drugs, dosages and duration
Susceptibility-based	No drug allergies
Clarithromycin Triple Therapy (susceptible to clarithromycin)	Amoxicillin (1 g) and clarithromycin (500 mg) plus a PPI all given twice daily for 14 days (40 mg esomeprazole equivalent per dose)
Metronidazole Triple Therapy (susceptible to metronidazole)	Amoxicillin (1 g) and tinidazole (500 mg) or metronidazole (500 mg) plus a PPI all given twice daily for 14 days (40 mg esomeprazole equivalent per dose)
Fluoroquinolone Triple Therapy (susceptible to fluoroquinolones)	Fluoroquinolone (e.g. levofloxacin 500 mg once daily), plus a PPI and amoxicillin 1 g twice daily for 14 days (40 mg esomeprazole equivalent per dose)
Susceptibility-based	Allergic to penicillin
Susceptible to clarithromycin and metronidazole	Clarithromycin (500 mg), and tinidazole (500 mg) or metronidazole (500 mg) plus a PPI (40 mg esomeprazole equivalent per dose) all given twice daily for 14 days
Resistant to clarithromycin and/or metronidazole	Bismuth quadruple therapy (see empiric therapies)
Empiric therapies	Susceptibility testing unavailable
Concomitant therapy	Amoxicillin (1 g), clarithromycin (500 mg), and tinidazole (500 mg) or metronidazole (500 mg) plus a PPI (40 mg esomeprazole equivalent per dose) all given twice daily for 14 days
Bismuth quadruple therapy	Bismuth subsalicylate or bismuth subcitrate 2 tablets and tetracycline hydrochloride (500 mg) both four times daily with meals and at bedtime plus metronidazole/tinidazole (500 mg) three times daily with meals and a PPI twice daily for 14 days (see text).
Prepackaged bismuth quadruple therapy	PYLERA for 14 days; add a PPI b.i.d. (40 mg esomeprazole equivalent per dose)

Preferred PPI's: Esomeprazole 40 mg, rabeprazole 20 mg. Vonoprazan can substitute for the PPI