1.

PPI (eg, omeprazole 20 mg BID, lansoprazole 30 mg BID, esomeprazole

40 mg QD, pantoprazole 40 mg QD, rabeprazole 20 mg BID) / plus
amoxicillin for 5-7 days (eg, pantoprazole 40 mg BID and amoxicillin 1 g BID for 7
days [15] ), then
2. 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) [11, 13, 14] and tetracycline-based regimens (eg, pantoprazole 40 mg BID,
tetracycline 500 mg QID, and metronidazole 500 mg BID) [15] are superior to 14-day
triple therapy, based on a meta-analysis of 21 trials

Tratament Mod administrare Comentarii

Standard triple A PPI (standard dose, bid), amoxicillin (1 g, bid) and Widely used option
therapy clarithromycin (500 mg, bid) for 14 d

Only suitable for areas with < 20%

incidence of cam resistance or as
tailored treatment.

Bismuth- A PPI (standard dose, bid), bismuth (standard Works independently to CAM and
containing dose, qid) tetracycline (500 mg, qid) and largely overcome MNZ resistance
quadruple metronidazole (500 mg, qid) for 10-14 d Valuable second-line treatment after
therapy failure of CAM-based regimens

Valuable second-line treatment after

failure of CAM-based regimens

Patient-friendly monocapsule
available
 Tratament Mod administrare Comentarii

Suitable for patients with penicillin

allergy

Non-availability of bismuth and/or

tetracycline in some countries

Sequential therapy A 5-d dual therapy with a PPI (standard dose, bid) Widely evaluated option
and amoxicillin (1 g, bid) followed by a 5-d triple
therapy with a PPI (standard dose, bid),
clarithromycin (500 mg, bid) and metronidazole (500 Probably effective in high resistance

mg, bid) settings

Questionable efficacy against

double-resistant strains

Less satisfactory results in more

recent studies contacted outside Italy

Non-bismuth A PPI (standard dose, bid), clarithromycin (500 Probably effective in high resistance
quadruple mg, bid), amoxicillin (1 g, bid) and metronidazole settings
“Concomitant” (500 mg, bid) for 10 d
therapy
Larger number of pills compared to
 Tratament Mod administrare Comentarii

sequential and hybrid therapies

Hybrid therapy A 7-d dual therapy with a PPI (standard dose, bid) Probably effective in high resistance
and amoxicillin (1 g, bid) followed by a 7-d settings
quadruple therapy with a PPI (standard dose, bid),
amoxicillin (1 g, bid), clarithromycin (500 mg, bid)
and metronidazole (500 mg, bid) Few data available on its
efficacy/safety

Second-line/rescue therapies

Levofloxacin-based A PPI (standard dose, bid), levofloxacin (500 Works independently to CAM and
triple therapy mg, bid) and amoxicillin (1 g, bid) for 10 d MNZ

Ineffective for high quinolone

resistance settings (> 10%)

Rapid development of quinolone

resistance

Rifabutin-based A PPI (standard dose, bid), rifabutin (150 mg bid) Third or more rescue option
 Tratament Mod administrare Comentarii

triple therapy and amoxicillin (1 g bid) for 14 d Significant safety issues

Development of mycobacterium
resistance

PPI: Proton pump inhibitor; CAM: Clarithromycin; MNZ: Metronidazole.