A new look at anti-Helicobacter pylori therapy

Table 1 Recommended regimens for Helicobacter pylori therapy

Treatment	Regimen
First-line therapy
Standard triple therapy1	A PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.) and amoxicillin (1 g, b.i.d.) for 7-14 d
Sequential therapy	A 5-d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 5-d triple therapy with a PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.) and metronidazole (500 mg, b.i.d.)
Concomitant therapy	A PPI (standard dose, b.i.d.), clarithromycin (500 mg, b.i.d.), amoxicillin (1 g, b.i.d.) and metronidazole (500 mg, b.i.d.) for 7-10 d
Hybrid therapy	A 7-d dual therapy with a PPI (standard dose, b.i.d.) and amoxicillin (1 g, b.i.d.) followed by a 7-d quadruple therapy with a PPI (standard dose, b.i.d.), amoxicillin (1 g, b.i.d.), Clarithromycin (500 mg, b.i.d.) and metronidazole (500 mg, b.i.d.)
Bismuth-containing quadruple therapy	A PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.) tetracycline (500 mg, q.i.d.) and metronidazole (250 mg, q.i.d.) for 10-14 d
Second-line therapy
Bismuth–containing quadruple therapy	A PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.) tetracycline (500 mg, q.i.d.) and metronidazole (500 mg, t.i.d.) for 10-14 d
Levofloxacin-based triple therapy2	A PPI (standard dose, b.i.d.), levofloxacin (500 mg, q.d.) and amoxicillin (1 g, b.i.d.) for 10 d
Third-line therapy
Culture-guided therapy	A 10-d quadruple therapy comprising a PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.) and two antibiotics selected by antimicrobial sensitivity tests
Levofloxacin-based quadruple therapy	A PPI (standard dose, b.i.d.), bismuth (standard dose, q.i.d.), levofloxacin (500 mg, q.d.) and amoxicillin (500 mg, q.i.d.) for 10 d
Rifabutin-based triple therapy	A PPI (standard dose, b.i.d.), rifabutin (150 mg b.i.d.) and amoxicillin (1 g b.i.d.) for 14 d
Furazolidone-based quadruple therapy	A PPI (standard dose, b.i.d.), tripotassium dicitratobismuthate (240 mg, b.i.d.), furazolidone (200 mg, b.i.d.) and tetracycline (1 g, b.i.d.)

¹Employed in areas with clarithromycin resistance < 10% and abandoned in areas with clarithromycin resistance ≥ 20%.

²Employed in patients who fail to eradicate Helicobacter pylori with standard triple therapy, sequential therapy, concomitant therapy or hybrid therapy. PPI: Proton pump inhibitor.