Regimens Recommended for Eradication of H. pylori Infection

Regimens Recommended for Eradication of H. pylori Infection

Regimens Recommended for Eradication of H. pylori Infection

Drug Dose Triple Therapy 1. Bismuth subsalicylate plus 2 tablets qid Metronidazole plus 250 mg qid Tetracyclinea 500 mg qid 2. Ranitidine bismuth citrate plus 400 mg bid Tetracycline plus 500 mg bid Clarithromycin or metronidazole 500 mg bid 3. Omeprazole (lansoprazole) plus 20 mg bid (30 mg bid) Clarithromycin plus 250 or 500 mg bid Metronidazoleb or 500 mg bid Amoxicillinc 1 g bid Quadruple Therapy Omeprazole (lansoprazole) 20 mg (30 mg) daily Bismuth subsalicylate 2 tablets qid Metronidazole 250 mg qid Tetracycline 500 mg qid

c Use either metronidazole or amoxicillin, not both.


Triple therapy, although effective, has several drawbacks, including the potential for poor patient compliance and drug-induced side effects. Compliance is being addressed by simplifying the regimens so that patients can take the medications twice a day. Simpler (dual therapy) and shorter regimens (7 and 10 days) are not as effective as triple therapy for 14 days. Two anti-H. pylori regimens are available in prepackaged formulation: Prevpac (lansoprazole, clarithromycin, and amoxicillin) and Helidac (bismuth subsalicylate, tetracycline, and metronidazole). The contents of the Prevpac are to be taken twice per day for 14 days, whereas Helidac constituents are taken four times per day with an antisecretory agent (PPI or H2 blocker), also for at least 14 days.

Side effects have been reported in up to 20–30% of patients on triple therapy. Bismuth may cause black stools, constipation, or darkening of the tongue. The most feared complication with amoxicillin is pseudomembranous colitis, but this occurs in <1–2%> Amoxicillin can also lead to antibiotic-associated diarrhea, nausea, vomiting, skin rash, and allergic reaction. Tetracycline has been reported to cause rashes and, very rarely, hepatotoxicity and anaphylaxis.

Antibiotic-resistant strains are the most common cause for treatment failure in compliant patients.