Table 1.

American College of Gastroenterology recommended first-line therapies for Helicobacter pylori infection. Adopted from Chey et al. [3]

Regimen	Drugs (doses)	Dosing frequency	Duration (days)	FDA approval
Clarithromycin triple	PPI (standard or double dose) Clarithromycin (500 mg) Amoxicillin (1 g) or Metronidazole (500 mg TID)	BID	14	Yesa
Bismuth quadruple	PPI (standard dose) Bismuth subcitrate (120–300 mg) or subsalicylate (300 mg) Tetracycline (500 mg) Metronidazole (250–500 mg)	BID QID QID QID (250) TID to QID (500)	10–14	Nob
Concomitant	PPI (standard dose) Clarithromycin (500 mg) Amoxicillin (1 g) Nitroimidazole (500 mg)c	BID	10–14	No
Sequential	PPI (standard dose) + amoxicillin (1 g) PPI, clarithromycin (500 mg) + nitroimidazole (500 mg)c	BID BID	5–7 5–7	No
Hybrid	PPI (standard dose) + amoxicillin (1 g) PPI, amoxicillin, clarithromycin (500 mg), nitroimidazole (500 mg)c	BID BID	7 7	No
Levofloxacin triple	PPI (standard dose) Levofloxacin (500 mg) Amoxicillin (1 g)	BID QD BID	10–14	No
Levofloxacin sequential	PPI (standard or double dose) + amoxicillin (1 g) PPI, amoxicillin, levofloxacin (500 mg QD), nitroimidazole (500 mg)c	BID BID	5–7 5–7	No
LOAD	Levofloxacin (250 mg) PPI (double dose) Nitazoxanide (500 mg) Doxycycline (100 mg)	QD QD BID QD	7–10	No

BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily

^aSeveral PPI, clarithromycin, and amoxicillin combinations have achieved FDA approval. PPI, clarithromycin and metronidazole is not an FDA-approved treatment regimen

^bPPI, bismuth, tetracycline, and metronidazole prescribed separately is not an FDA-approved treatment regimen. However, Pylera, a combination product containing bismuth subcitrate, tetracycline, and metronidazole combined with a PPI for 10 days is an FDA-approved treatment regimen

^cMetronidazole or tinidazole