Recommended First-Line Therapies for H. pylori Infection | ||||
| REGIMEN | DRUGS (DOSES) | DOSING FREQUENCY | DURATION (DAYS) | FDA APPROVAL |
|---|---|---|---|---|
| Clarithromycin triple | PPI (standard or double dose) | BID | 14 | Yesa |
| Clarithromycin (500 mg) | ||||
| Amoxicillin (1 g) or Metronidazole (500 mg TID) | ||||
| Bismuth quadruple | PPI (standard dose) | BID | 10-14 | Nob |
| Bismuth subcitrate (120-300 mg) or Subsalicylate (300 mg) | QID | |||
| Tetracycline (500 mg) | QID | |||
| Metronidazole (250-500 mg) | QID (250) TID to QID (500) | |||
| Concomitant | PPI (standard dose) | BID | 10-14 | No |
| Clarithromycin (500 mg) | ||||
| Amoxicillin (1 g) | ||||
| Nitroimidazole (500 mg)c | ||||
| Sequential | PPI (standard dose) | BID | 5-7 | No |
| PPI, Clarithromycin (500 mg) + Nitroimidazole (500 mg)c | BID | 5-7 | ||
| Hybrid | PPI (standard dose) + Amox (1 g) | BID | 7 | No |
| PPI, Amox, Clarithromycin (500 mg), Nitroimidazole (500 mg)C | BID | 7 | ||
| Levofloxacin triple | PPI (standard or double dose) + Amox (1 g) | BID | 5-7 | No |
| Levofloxacin (500 mg) | QD | |||
| Amox (1 g) | BID | |||
| Levofloxacin sequential | PPI (standard or double dose) + Amox (1 g) | BID | 5-7 | No |
| PPI, Amox, Levofloxacin (500 mg QD), Nitroimidazole (500 mg)c | BID | 5-7 | ||
| LOAD | Levofloxacin (250 mg) | QD | 7-10 | No |
| PPI (double dose) | QD | |||
| Nitazoxanide (500 mg) | BID | |||
| Doxycycline (100 mg) | QD | |||
a Several PPI, clarithromycin, and amoxicillin combinations have achieved FDA approval. PPI, clarithromycin, and metronidazole is not an FDA-approved treatment regimen.
b PPI, bismuth, tetracycline, and metronidazole combined with a PPI for 10 days is an FDA-approved treatment regimen.
c Metronidazole or tinidazole.
Abbreviations: BID, twice daily; FDA, Food and Drug Administration; PPI, proton pump inhibitor; TID, three times daily; QD, once daily; QID, four times daily.
Source: Adapted with permission from Wolters Kluwer Health, Inc.: Chey WD et al: ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol 112:212, 2017.