Table 1.
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