Helicobacter pylori Infection Treatment

Updated: Aug 16, 2022

Author: Joseph Adrian L Buensalido, MD;

Helicobacter pylori Infection Treatment

Regimens for eradication of Helicobacter pylori infection are typically chosen empirically, on the basis of regional bacterial resistance patterns, local recommendations, and drug availability.[1] Therapy for H pylori infection has undergone major changes, based on application of the principles of antimicrobial stewardship and increased availability of susceptibility testing. Common initial choices for empiric treatment include a 14-day bismuth-based quadruple therapy or rifabutin-based triple therapy. However, clinicians should use regimens shown to be highly effective locally.[2] In addition, health care providers should ask their patients about any prior antibiotic use or exposure, and take that information into consideration in the choice of a treatment regimen.[3]

The following regimens are described below[4] :

Triple therapy
Non-bismuth quadruple therapy
Bismuth-based therapy
Levofloxacin-containing therapy
Concomitant bismuth- and levofloxacin-containing therapy
Second-line therapy
Rescue or third-line therapy

Triple therapy

Proton pump inhibitor (PPI)–based triple therapy for Hpylori infection remains an option for first-line therapy in areas of low (< 15%) clarithromycin resistance[5] and consists of the following:

PPI (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole 40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID)[3, 6] plus
Clarithromycin 500 mg BID[6] (first-line and continues to be recommended in areas where H pylori clarithromycin resistance is less than 15% and in patients without previous macrolide exposure[3] ) ormetronidazole 500 mg BID[6] (when clarithromycin resistance is increasing)[7, 8] plus
Amoxicillin 1000 mg BID[6] or metronidazole 500 mg BID[9] (if not already selected)

Prepackaged versions of those peptic ulcer disease combination regimens (PUD Combos) include the following:

Omeclamox-Pak (omeprazole/amoxicillin/clarithromycin)
Prevpac (lansoprazole/amoxicillin/clarithromycin)

A rifabutin-based triple-therapy regimen consists of the following three agents given together every 8 hours for 14 days[10] :

Amoxicillin 1 g plus
Omeprazole 40 mg plus
Rifabutin 50 mg

This regimen is available prepackaged as Talicia. The US Food and Drug Administration (FDA) approved Talicia for treatment of H pylori infection in 2019, based in part on results of two phase III studies that showed eradication rates of 84.1% and 90.3%.[11, 10]

The first potassium-competitive acid blocker (PCAB)–based therapy was approved by the FDA in May 2022 and consists of triple therapy for 14 days with the following[12] :

Vonoprazan (PCAB) 20 mg BID plus
Amoxicillin 1000 mg BID plus
Clarithromycin 500 mg BID

This regimen is available as Voquezna Triple Pak.

Duration

A Cochrane meta-analysis of 55 studies concluded that 14 days is the optimal duration of triple therapy, achieving an H pylori eradication rate of 81.9%, whereas 7 days attains an eradication rate of only 72.9%.[13] In more recent studies, however, the eradication rate with 14-day triple therapy is not significantly different from that with 10-day sequential therapy (amoxicillin and a PPI for 5 days followed by a PPI, clarithromycin and metronidazole for another 5 days)[14] or 10-day concomitant nonbismuth quadruple therapy.[15]

Non-bismuth quadruple therapy

Non-bismuth quadruple therapy may be given sequentially or concomitantly.[4]

Sequential therapy

Sequential therapy (a suggested first-line option[3] ) is superior to standard triple therapy, according to two systematic reviews,[16, 17] and consists of the following:

PPI plus amoxicillin for 5-7 days (eg, pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days[18] ), then
PPI plus 2 other antibiotics for the next 5-7 days; clarithromycin and metronidazole are the antibiotics usually chosen, but levofloxacin-based regimens (see below)[16, 19, 20] and tetracycline-based regimens (eg, pantoprazole 40 mg BID, tetracycline 500 mg QID, and metronidazole 500 mg BID)[18] are superior to 14-day triple therapy, based on a meta-analysis of 21 trials[16]

Eradication rates with different durations of sequential therapy are as follows:

14 days: 90.7-92.5% eradication rates ^{[21, 22]}
10 days: 87% eradication rate ^{[3, 6, 21]}

Concomitant therapy

Concomitant therapy (an alternative first-line option[3] ) consists of the following (using dosages similar to those in triple therapy; or all drugs BID in one study):

PPI plus
Amoxicillin plus
Clarithromycin (1 g modified-release tablet QD in one study) plus
Metronidazole (500 mg TID in one study)

Duration of concomitant therapy is 10-14 days.[3, 23, 24]

Concomitant therapy is better for clarithromycin-resistant strains,[23, 5] and 14 days of concomitant therapy is superior to 14-day triple therapy, with cure rates of ≥90%.[25, 26, 27, 28]

Hybrid therapy

Hybrid therapy is a combination of sequential and concomitant therapy,[4, 29, 30] as follows:

PPI plus amoxicillin for 3-7 days (the latter recommended as another suggested first-line option in the 2017 American College of Gastroenterology guideline[3] ), then
PPI plus amoxicillin plus 2 other antibiotics (usually, clarithromycin and metronidazole) for 7 days

There is evidence that the eradication rates with 10-day, 12-day, and 14-day regimens are comparable, at 95.0%, 95.1%, and 93.4%, respectively. This suggests that the optimal duration of hybrid therapy is 12 days, since high rates of eradication are still achieved.

When compared with 14 days of bismuth-containing quadruple therapy, a 14-day hybrid therapy regimen (7 days of dual therapy with pantoprazole plus amoxicillin, followed by 7 days of quadruple therapy with pantoprazole plus amoxicillin, clarithromycin, and metronidazole) showed comparable drug adherence and eradication rates, but with a significantly lower rate of adverse effects (15.7%, versus 55.5% with bismuth-containing quadruple therapy; P < 0.001).[31]

Reverse hybrid therapy

Reverse hybrid therapy is a combination of sequential and concomitant therapy, using the same drugs as hybrid therapy but in reverse sequence,[30] as follows:

PPI plus amoxicillin plus 2 other antibiotics (usually, clarithromycin and metronidazole) for 7 days then
PPI plus amoxicillin for 3–7 days

The eradication rate achieved with 12 days of reverse hybrid therapy is similar to that with 12 days of hybrid therapy (95.7% vs. 95.1%, respectively). Fourteen-day reverse hybrid therapy as first-line treatment has equivalent efficacy but less adverse effects than 14-day concomitant therapy, according to a randomized, controlled trial from Taiwan.[32]

Novel concomitant therapy

Novel concomitant therapy consists of the following agents, which are given for 10 days[33] :

PPI (eg, rabeprazole 20 mg TID) plus
Amoxicillin 1 g TID for 10 days (or, if penicillin allergic, bismuth subcitrate 240 mg QID plus
Rifabutin 150 mg BID plus
Ciprofloxacin 500 mg BID

A small randomized trial in Taiwan reported that 14-day high-dose dual therapy with esomeprazole (40 mg TID) and amoxicillin (750 mg QID) as first-line treatment yielded an eradication rate similar to that of a 7-day non-bismuth quadruple therapy.[34]

Bismuth-based therapy

Bismuth-based therapy is an alternative first-line therapy (in areas with high clarithromycin and metronidazole resistance, and in patients with prior macrolide exposure or penicillin-allergic)[5, 3] or second-line therapy (see below).[4] It consists of the following:

PPI or H2 receptor antagonist (eg, lansoprazole 30 mg BID^[15]or ranitidine 150 mg BID^[6]) plus
Bismuth subsalicylate 525 mg QID^[6] (or bismuth tripotassium dicitrate 300 mg QID^[15]) plus
Metronidazole 250 mg QID^[6] or 500 mg TID^[15] (or levofloxacin 500 mg QD)^[35] plus
Tetracycline 500 mg QID^[6]

Duration is 10-14 days.[3, 6, 36, 15] The eradication rate was 90.4% for 10 days of bismuth quadruple therapy, while extending therapy to 14 days achieved an eradication rate of 97.1%[36]

Chinese researchers reported that the following regimen provides effective first-line treatment in a population with high antibiotic resistance[37] :

Rabeprazole 10 mg BID plus
Bismuth potassium citrate 220 mg BID plus
Amoxicillin 1000 mg BID plus
Clarithromycin 500 mg BID

Duration is 10 days. Rabeprazole and bismuth were given 30 min before the morning and evening meals. Antibiotics were given 30 min after the morning and evening meals.[37]

Researchers in Turkey, however, reported that a 14-day regimen of lansoprazole 30 mg BID, amoxicillin 1000 mg BID, clarithromycin 500 mg BID, bismuth subsalicylate 600 mg BID was not significantly superior to a 7-day regimen (81.4% vs. 80%).[38]

Levofloxacin-containing therapy

This is an alternative first-line regimen[19, 39] and consists of a PPI plus amoxicillin 1 g BID plus levofloxacin 500 mg QD.[6]

Duration options are as follows:

7 days (eradication rates of up to 80.9%) ^{[19, 39, 40]}
10 days (eradication rates of up to 83.1%) ^{[3, 6, 41]}
10-14 days is recommended by the 2017 American College of Gastroenterology guidelines ^[3]

Sequential therapy, an alternative first-line regimen, is as follows (eradication rates of up to 86.5%):[42, 19, 16, 3]

PPI (esomeprazole 20 mg or 40 mg BID) plus amoxicillin (1 g BID) for 5-7 days, then
PPI (esomeprazole 20 mg or 40 mg BID) plus levofloxacin (250 mg or 500 mg BID) plus a nitroimidazole antibiotic (eg, tinidazole 500 mg BID) for 5-7 days

A randomized trial investigated the role of bismuth in levofloxacin-containing 14-day sequential therapy, and concluded that adding bismuth did not significantly improve eradication rates (85.2% vs. 82.6%).

Concomitant therapy, another alternative first-line regimen, is as follows (eradication rates of up to 96.5%)[43] :

PPI (esomeprazole 40 mg BID) plus amoxicillin (1 g BID) plus levofloxacin (500 mg QD) plus another antibiotic (eg, tinidazole 500 mg BID) for 5 days

Concomitant bismuth- and levofloxacin-containing therapy

A group of Chinese researchers reported that the following regimen also provided satisfactory eradication rates in a population with high antibiotic resistance:

Esomeprazole 20 mg BID plus
Levofloxacin 500 mg BID plus
Bismuth 220 mg BID plus
Amoxicillin 1000 mg BID or cefuroxime 500 mg BID

Duration: 14 days. Eradication rates were not significantly different between the amoxicillin and cefuroxime groups (83.5% vs 81%).[44]

An open-label, randomized trial conducted in China reported acceptable eradication rates even for the following 1-week bismuth-containing regimen:

Esomeprazole 20 mg BID plus
Colloidal bismuth pectin 200 mg BID plus
Amoxicillin 1000 mg BID plus
Levofloxacin 500 mg OD or clarithromycin 500 mg BID

The above levofloxacin-based concomitant quadruple regimen demonstrated a higher eradication rate (86.66% vs 76.22%).[45]

Second-line therapy

Second-line therapy[4, 46] should avoid repeating first-line regimens that were already used, and should incorporate at least one different antibiotic. Bismuth-based therapy or levofloxacin-containing triple therapy[46] can be used (same regimens as above, if not used previously).

In a meta-analysis of 115 heterogeneous studies, per protocol analysis showed that quadruple therapies have better cure rate than triple (83% vs 76%) and 14-day quadruple treatment than 7-day regimens (91% vs 81%).[47]

Rescue or third-line therapy

Before initiating rescue/third-line therapy, send ulcer biopsy specimen for culture and antimicrobial susceptibility testing.[4, 46, 5] It is essential to avoid antimicrobials that have previously been used. The preferred treatments for patients who have received a clarithromycin-containing first-line regimen are bismuth quadruple therapy or levofloxacin-salvage combination therapy. In general, clarithromycin triple therapy is not recommended for salvage treatment.[3]

Salvage regimens

Bismuth-based quadruple therapy is used for 14 days and comprises the following (eradication rates for all combinations below were above 90%)[48] :

PPI (lansoprazole 30 mg BID) plus
Bismuth potassium citrate 220 mg BID plus
Tetracycline 500 mg QID or amoxicillin 1 g TID plus
Tetracycline 500 mg QID (if not already selected) or metronidazole 400 mg QID

For patients who already received bismuth quadruple therapy as first-line treatment, clarithromycin or levofloxacin-containing salvage regimens are preferred.[3]

Levofloxacin-based sequential therapy is superior to clarithromycin- and tetracycline-based therapies and consists of the following (eradication rates of up to 92.2%, as long as the H pylori was susceptible to levofloxacin):[20]

PPI (esomeprazole 40 mg BID) + amoxicillin (1 g BID) for 7 days, then
PPI (esomeprazole 40 mg BID) + metronidazole (500 mg BID) + levofloxacin (250 mg or 500 mg BID, with the former surprisingly achieving higher cure rates^[16]) for another 7 days

Other salvage regimens that can be recommended are the following[3] :

Triple therapy (which includes levofloxacin) is also a recommended salvage regimen (see above)
Concomitant therapy as described above
14-day rifabutin triple salvage regimen (PPI plus amoxicillin plus rifabutin)
High-dose dual therapy (PPI plus amoxicillin for 14 days)

Pooled eradication rates for rifabutin triple therapy were 79%, 66%, and 70% as a second-, third-, and fourth/fifth-line regimen, respectively, according to a meta-analysis of cohort studies.[49]

Adjuvant therapies

More conclusive evidence is needed to support the role of the following as potential adjuvant therapies:

Probiotics ^[50]
Statins ^[51]

Questions & Answers

Overview

Which empirical therapy regimens are used for eradication of Helicobacter pylori infection?

What is concomitant nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

What is included in triple therapy for eradication of Helicobacter pylori infection?

How is nonbismuth quadruple therapy administered for eradication of Helicobacter pylori infection?

What is sequential nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

What are eradication rates of sequential nonbismuth quadruple therapy for Helicobacter pylori infection?

What is hybrid nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

What is reverse hybrid nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

What is novel concomitant nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

What is bismuth-based therapy for the eradication of Helicobacter pylori infection?

Which bismuth-based therapy for the eradication of Helicobacter pylori infection may be effective for antibiotic-resistant pathogens?

What is levofloxacin-containing therapy for the eradication of Helicobacter pylori infection?

What is sequential levofloxacin-containing therapy for the eradication of Helicobacter pylori infection?

What is concomitant levofloxacin-containing therapy for the eradication of Helicobacter pylori infection?

What are the second-line therapies for the eradication of Helicobacter pylori infection?

What are the rescue or third-line therapies for the eradication of Helicobacter pylori infection?

What is concomitant bismuth and levofloxacin-containing therapy for the eradication of Helicobacter pylori infection?

Flores-Treviño S, Mendoza-Olazarán S, Bocanegra-Ibarias P, Maldonado-Garza HJ, Garza-González E. Helicobacter pylori drug resistance: therapy changes and challenges. Expert Rev Gastroenterol Hepatol. 2018 Jul 5. [QxMD MEDLINE Link].
Shiotani A, Roy P, Lu H, Graham DY. Helicobacter pylori diagnosis and therapy in the era of antimicrobial stewardship. Therap Adv Gastroenterol. 2021. 14:17562848211064080. [QxMD MEDLINE Link]. [Full Text].
[Guideline] Chey WD, Leontiadis GI, Howden CW, Moss SF. ACG Clinical Guideline: Treatment of Helicobacter pylori Infection. Am J Gastroenterol. 2017 Feb. 112 (2):212-239. [QxMD MEDLINE Link].
O'Connor A, Molina-Infante J, Gisbert JP, O'Morain C. Treatment of Helicobacter pylori infection 2013. Helicobacter. 2013 Sep. 18 Suppl 1:58-65. [QxMD MEDLINE Link].
Malfertheiner P, Megraud F, O'Morain CA, Gisbert JP, Kuipers EJ, Axon AT et. al. Management of Helicobacter pylori infection-the Maastricht V/Florence Consensus Report. Gut. 2017 Jan. 66 (1):6-30. [QxMD MEDLINE Link].
Chey WD, Wong BC. American College of Gastroenterology guideline on the management of Helicobacter pylori infection. Am J Gastroenterol. 2007 Aug. 102(8):1808-25. [QxMD MEDLINE Link].
Sánchez-Delgado J, García-Iglesias P, Castro-Fernández M, Bory F, Barenys M, Bujanda L. High-dose, ten-day esomeprazole, amoxicillin and metronidazole triple therapy achieves high Helicobacter pylori eradication rates. Aliment Pharmacol Ther. 2012 Jul. 36(2):190-6. [QxMD MEDLINE Link].
Nishizawa T, Maekawa T, Watanabe N, Harada N, Hosoda Y, Yoshinaga M, et al. Clarithromycin Versus Metronidazole as First-line Helicobacter pylori Eradication: A Multicenter, Prospective, Randomized Controlled Study in Japan. J Clin Gastroenterol. 2015 Jul. 49 (6):468-71. [QxMD MEDLINE Link].
Malfertheiner P, Mégraud F, O'Morain C, Bell D, Bianchi Porro G, Deltenre M, et al. Current European concepts in the management of Helicobacter pylori infection--the Maastricht Consensus Report. The European Helicobacter Pylori Study Group (EHPSG). Eur J Gastroenterol Hepatol. 1997 Jan. 9(1):1-2. [QxMD MEDLINE Link].
Graham DY, Canaan Y, Maher J, Wiener G, Hulten KG, Kalfus IN. Rifabutin-Based Triple Therapy (RHB-105) for Helicobacter pylori Eradication: A Double-Blind, Randomized, Controlled Trial. Ann Intern Med. 2020 Jun 16. 172 (12):795-802. [QxMD MEDLINE Link].
Kalfus IN, Graham DY, Riff DS, Panas RM. Rifabutin-Containing Triple Therapy (RHB-105) for Eradication of Helicobacter pylori: Randomized ERADICATE Hp Trial. Antibiotics (Basel). 2020 Oct 9. 9 (10):[QxMD MEDLINE Link]. [Full Text].
Chey WD, Mégraud F, Laine L, López LJ, Hunt BJ, Howden CW. Vonoprazan Triple and Dual Therapy for Helicobacter pylori Infection in the United States and Europe: Randomized Clinical Trial. Gastroenterology. 2022 Jun 6. Vol 116 (S634):[QxMD MEDLINE Link]. [Full Text].
Yuan Y, Ford AC, Khan KJ, Gisbert JP, Forman D, Leontiadis GI, et al. Optimum duration of regimens for Helicobacter pylori eradication. Cochrane Database Syst Rev. 2013 Dec 11. CD008337. [QxMD MEDLINE Link].
Nyssen OP, McNicholl AG, Megraud F, Savarino V, Oderda G, Fallone CA, et al. Sequential versus standard triple first-line therapy for Helicobacter pylori eradication. Cochrane Database Syst Rev. 2016 Jun 28. CD009034. [QxMD MEDLINE Link].
Liou JM, Fang YJ, Chen CC, Bair MJ, Chang CY, Lee YC et. al. Concomitant, bismuth quadruple, and 14-day triple therapy in the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2016 Nov 12. 388 (10058):2355-2365. [QxMD MEDLINE Link].
Zullo A, De Francesco V, Hassan C, Ridola L, Repici A, Bruzzese V, et al. Modified sequential therapy regimens for Helicobacter pylori eradication: a systematic review. Dig Liver Dis. 2013 Jan. 45(1):18-22. [QxMD MEDLINE Link].
Zullo A, Hassan C, Ridola L, De Francesco V, Vaira D. Standard triple and sequential therapies for Helicobacter pylori eradication: an update. Eur J Intern Med. 2013 Jan. 24(1):16-9. [QxMD MEDLINE Link].
Uygun A, Kadayifci A, Yesilova Z, Safali M, Ilgan S, Karaeren N. Comparison of sequential and standard triple-drug regimen for Helicobacter pylori eradication: a 14-day, open-label, randomized, prospective, parallel-arm study in adult patients with nonulcer dyspepsia. Clin Ther. 2008 Mar. 30 (3):528-34. [QxMD MEDLINE Link].
Qian J, Ye F, Zhang J, Yang YM, Tu HM, Jiang Q, et al. Levofloxacin-containing triple and sequential therapy or standard sequential therapy as the first line treatment for Helicobacter pylori eradication in China. Helicobacter. 2012 Dec. 17(6):478-85. [QxMD MEDLINE Link].
Liou JM, Chen CC, Chang CY, Chen MJ, Fang YJ, Lee JY, et al. Efficacy of genotypic resistance-guided sequential therapy in the third-line treatment of refractory Helicobacter pylori infection: a multicentre clinical trial. J Antimicrob Chemother. 2013 Feb. 68(2):450-6. [QxMD MEDLINE Link].
Liou JM, Chen CC, Chen MJ, Chen CC, Chang CY, Fang YJ. Sequential versus triple therapy for the first-line treatment of Helicobacter pylori: a multicentre, open-label, randomised trial. Lancet. 2013 Jan 19. 381(9862):205-13. [QxMD MEDLINE Link].
Manfredi M, Bizzarri B, de'Angelis GL. Helicobacter pylori infection: sequential therapy followed by levofloxacin-containing triple therapy provides a good cumulative eradication rate. Helicobacter. 2012 Aug. 17(4):246-53. [QxMD MEDLINE Link].
Molina-Infante J, Pazos-Pacheco C, Vinagre-Rodriguez G, Perez-Gallardo B, Dueñas-Sadornil C, Hernandez-Alonso M. Nonbismuth quadruple (concomitant) therapy: empirical and tailored efficacy versus standard triple therapy for clarithromycin-susceptible Helicobacter pylori and versus sequential therapy for clarithromycin-resistant strains. Helicobacter. 2012 Aug. 17(4):269-76. [QxMD MEDLINE Link].
Kongchayanun C, Vilaichone RK, Pornthisarn B, Amornsawadwattana S, Mahachai V. Pilot studies to identify the optimum duration of concomitant Helicobacter pylori eradication therapy in Thailand. Helicobacter. 2012 Aug. 17(4):282-5. [QxMD MEDLINE Link].
Georgopoulos S, Papastergiou V, Xirouchakis E, Laoudi F, Lisgos P, Spiliadi C. Nonbismuth quadruple "concomitant" therapy versus standard triple therapy, both of the duration of 10 days, for first-line H. pylori eradication: a randomized trial. J Clin Gastroenterol. 2013 Mar. 47(3):228-32. [QxMD MEDLINE Link].
Kim SY, Lee SW, Hyun JJ, Jung SW, Koo JS, Yim HJ. Comparative study of Helicobacter pylori eradication rates with 5-day quadruple "concomitant" therapy and 7-day standard triple therapy. J Clin Gastroenterol. 2013 Jan. 47(1):21-4. [QxMD MEDLINE Link].
Yanai A, Sakamoto K, Akanuma M, Ogura K, Maeda S. Non-bismuth quadruple therapy for first-line Helicobacter pylori eradication: A randomized study in Japan. World J Gastrointest Pharmacol Ther. 2012 Feb 6. 3(1):1-6. [QxMD MEDLINE Link].
Molina-Infante J, Lucendo AJ, Angueira T, Rodriguez-Tellez M, Perez-Aisa A, Balboa A, et al. Optimised empiric triple and concomitant therapy for Helicobacter pylori eradication in clinical practice: the OPTRICON study. Aliment Pharmacol Ther. 2015 Mar. 41 (6):581-9. [QxMD MEDLINE Link].
Sardarian H, Fakheri H, Hosseini V, Taghvaei T, Maleki I, Mokhtare M. Comparison of hybrid and sequential therapies for Helicobacter pylori eradication in Iran: a prospective randomized trial. Helicobacter. 2013 Apr. 18(2):129-34. [QxMD MEDLINE Link].
Hsu PI, Kao SS, Wu DC, Chen WC, Peng NJ, Yu HC, et al. A Randomized Controlled Study Comparing Reverse Hybrid Therapy and Standard Triple Therapy for Helicobacter pylori Infection. Medicine (Baltimore). 2015 Dec. 94 (48):e2104. [QxMD MEDLINE Link].
Tsay FW, Wu DC, Yu HC, Kao SS, Lin KH, Cheng JS, et al. A Randomized Controlled Trial Shows that both 14-Day Hybrid and Bismuth Quadruple Therapies Cure Most Patients with Helicobacter pylori Infection in Populations with Moderate Antibiotic Resistance. Antimicrob Agents Chemother. 2017 Nov. 61 (11):[QxMD MEDLINE Link].
Hsu PI, Tsay FW, Kao JY, Peng NJ, Tsai KW, Tsai TJ, et al. Equivalent efficacies of reverse hybrid and concomitant therapies in first-line treatment of Helicobacter pylori infection. J Gastroenterol Hepatol. 2020 Oct. 35 (10):1731-1737. [QxMD MEDLINE Link].
Tay CY, Windsor HM, Thirriot F, Lu W, Conway C, Perkins TT. Helicobacter pylori eradication in Western Australia using novel quadruple therapy combinations. Aliment Pharmacol Ther. 2012 Dec. 36(11-12):1076-83. [QxMD MEDLINE Link].
Tai WC, Liang CM, Kuo CM, Huang PY, Wu CK, Yang SC, et al. A 14 day esomeprazole- and amoxicillin-containing high-dose dual therapy regimen achieves a high eradication rate as first-line anti-Helicobacter pylori treatment in Taiwan: a prospective randomized trial. J Antimicrob Chemother. 2019 Jun 1. 74 (6):1718-1724. [QxMD MEDLINE Link].
Kuo CH, Hsu PI, Kuo FC, Wang SS, Hu HM, Liu CJ. Comparison of 10 day bismuth quadruple therapy with high-dose metronidazole or levofloxacin for second-line Helicobacter pylori therapy: a randomized controlled trial. J Antimicrob Chemother. 2013 Jan. 68(1):222-8. [QxMD MEDLINE Link].
Salazar CO, Cardenas VM, Reddy RK, Dominguez DC, Snyder LK, Graham DY. Greater than 95% success with 14-day bismuth quadruple anti- Helicobacter pylori therapy: a pilot study in US Hispanics. Helicobacter. 2012 Oct. 17(5):382-90. [QxMD MEDLINE Link].
Xie Y, Zhu Z, Wang J, Zhang L, Zhang Z, Lu H, et al. Ten-day quadruple therapy comprising low-dose rabeprazole, bismuth, amoxicillin and tetracycline is an effective and safe first-line treatment for Helicobacter pylori infection in population with high antibiotic resistance: a prospective, multicenter, randomized, parallel-controlled clinical trial in China. Antimicrob Agents Chemother. 2018 Jun 18. [QxMD MEDLINE Link]. [Full Text].
Yagbasan A, Coşkun DÖ, Özbakir Ö, Deniz K, Gürsoy Ş, Yücesoy M. A Prospective, randomized study comparing 7-day and 14-day quadruple therapies as first-line treatments for helicobacter pylori infection in patients with functional dyspepsia. Niger J Clin Pract. 2018 Jan. 21 (1):54-58. [QxMD MEDLINE Link].
Shah A, Javid G, Zargar SA, Teli F, Khan BA, Yattoo GN. Safety and efficacy of 1-week levofloxacin-based triple therapy in first-line treatment for Helicobacter pylori-related peptic ulcer disease in Kashmir, India. Indian J Gastroenterol. 2013 Jan. 32(1):32-6. [QxMD MEDLINE Link].
Peedikayil MC, Alsohaibani FI, Alkhenizan AH. Levofloxacin-based first-line therapy versus standard first-line therapy for Helicobacter pylori eradication: meta-analysis of randomized controlled trials. PLoS One. 2014 Jan 21. 9 (1):e85620. [QxMD MEDLINE Link].
Cuadrado-Lavín A, Salcines-Caviedes JR, Carrascosa MF, Dierssen-Sotos T, Cobo M, Campos MR, et al. Levofloxacin versus clarithromycin in a 10 day triple therapy regimen for first-line Helicobacter pylori eradication: a single-blind randomized clinical trial. J Antimicrob Chemother. 2012 Sep. 67(9):2254-9. [QxMD MEDLINE Link].
Kale-Pradhan PB, Mihaescu A, Wilhelm SM. Fluoroquinolone Sequential Therapy for Helicobacter pylori: A Meta-analysis. Pharmacotherapy. 2015 Aug. 35 (8):719-30. [QxMD MEDLINE Link].
Federico A, Nardone G, Gravina AG, Iovene MR, Miranda A, Compare D. Efficacy of 5-day levofloxacin-containing concomitant therapy in eradication of Helicobacter pylori infection. Gastroenterology. 2012 Jul. 143(1):55-61.e1; quize e13-4. [QxMD MEDLINE Link].
Fu W, Song Z, Zhou L, Xue Y, Ding Y, Suo B, et al. Randomized Clinical Trial: Esomeprazole, Bismuth, Levofloxacin, and Amoxicillin or Cefuroxime as First-Line Eradication Regimens for Helicobacter pylori Infection. Dig Dis Sci. 2017 Jun. 62 (6):1580-1589. [QxMD MEDLINE Link].
Su J, Zhou X, Chen H, Hao B, Zhang W, Zhang G. Efficacy of 1st-line bismuth-containing quadruple therapies with levofloxacin or clarithromycin for the eradication of Helicobacter pylori infection: A 1-week, open-label, randomized trial. Medicine (Baltimore). 2017 Feb. 96 (7):e5859. [QxMD MEDLINE Link].
Malfertheiner P, Megraud F, O'Morain CA, Atherton J, Axon AT, Bazzoli F. Management of Helicobacter pylori infection--the Maastricht IV/ Florence Consensus Report. Gut. 2012 May. 61(5):646-64. [QxMD MEDLINE Link].
Muñoz N, Sánchez-Delgado J, Baylina M, Puig I, López-Góngora S, Suarez D, et al. Systematic review, meta-analysis, and meta-regression: Successful second-line treatment for Helicobacter pylori. Helicobacter. 2018 Jun. 23 (3):e12488. [QxMD MEDLINE Link].
Liang X, Xu X, Zheng Q, Zhang W, Sun Q, Liu W. Efficacy of bismuth-containing quadruple therapies for clarithromycin-, metronidazole-, and fluoroquinolone-resistant Helicobacter pylori infections in a prospective study. Clin Gastroenterol Hepatol. 2013 Jul. 11(7):802-7.e1. [QxMD MEDLINE Link].
Gisbert JP, Calvet X. Review article: rifabutin in the treatment of refractory Helicobacter pylori infection. Aliment Pharmacol Ther. 2012 Jan. 35 (2):209-21. [QxMD MEDLINE Link]. [Full Text].
Goderska K, Agudo Pena S, Alarcon T. Helicobacter pylori treatment: antibiotics or probiotics. Appl Microbiol Biotechnol. 2018 Jan. 102 (1):1-7. [QxMD MEDLINE Link].
Sarkeshikian SS, Ghadir MR, Alemi F, Jalali SM, Hormati A, Mohammadbeigi A. Atorvastatin in combination with conventional antimicrobial treatment of Helicobacter pylori eradication: A randomized controlled clinical trial. J Gastroenterol Hepatol. 2020 Jan. 35 (1):71-75. [QxMD MEDLINE Link].
Li M, Oshima T, Horikawa T, Tozawa K, Tomita T, Fukui H, et al. Systematic review with meta-analysis: Vonoprazan, a potent acid blocker, is superior to proton-pump inhibitors for eradication of clarithromycin-resistant strains of Helicobacter pylori. Helicobacter. 2018 Aug. 23 (4):e12495. [QxMD MEDLINE Link].
Sokwala A, Shah MV, Devani S, Yonga G. Helicobacter pylori eradication: A randomised comparative trial of 7-day versus 14-day triple therapy. S Afr Med J. 2012 Jun. 102(6 Pt 2):368-71. [QxMD MEDLINE Link].
Celik M, Yigit M. The efficiency of Levofloxacin Containing Sequential Therapy with or without Bismuth, in Helicobacter Pylori Eradication, in Non-ulcer Dyspepsia. Acta Gastroenterol Belg. 2017 Jan-Mar. 80 (1):39-42. [QxMD MEDLINE Link].
Tsay FW, Wu DC, Yu HC, Kao SS, Lin KH, Cheng JS, et al. A Randomized Controlled Trial Shows that both 14-Day Hybrid and Bismuth Quadruple Therapies Cure Most Patients with Helicobacter pylori Infection in Populations with Moderate Antibiotic Resistance. Antimicrob Agents Chemother. 2017 Nov. 61 (11):[QxMD MEDLINE Link].

Helicobacter pylori Infection Treatment