Update on triple therapy for eradication of Helicobacter pylori: current status of the art

Figures & data

Table 1 Regimens for Helicobacter pylori therapy

First-line therapy
Standard triple therapy	PPI (standard dose, bid), clarithromycin (500 mg, bid) and amoxicillin (1 g, bid) for 7–14 days
Concomitant therapy	PPI (standard dose, bid), clarithromycin (500 mg, bid), amoxicillin (1 g, bid) and metronidazole (500 mg, bid) for 7–10 days
Hybrid therapy	7-day dual therapy with a PPI (standard dose, bid) and amoxicillin (1 g, bid) followed by a 7-day quadruple therapy with a PPI (standard dose, bid), amoxicillin (1 g, bid), clarithromycin (500 mg, bid), and metronidazole (500 mg, bid)
Bismuth-containing quadruple therapy	PPI (standard dose, bid), bismuth (standard dose, qid), tetracycline (500 mg, qid), and metronidazole (250 mg, qid) for 10–14 days
Second-line therapy
Levofloxacin-based triple therapy	PPI (standard dose, bid), levofloxacin (500 mg, qd), and amoxicillin (1 g, bid) for 10 days
Bismuth-containing quadruple therapy	PPI (standard dose, bid), bismuth (standard dose, qid), tetracycline (500 mg, qid), and metronidazole (500 mg, tid) for 10–14 days
Sequential therapy
Sequential therapy	5-day dual therapy with a PPI (standard dose, bid) and amoxicillin (1 g, bid) followed by a 5-day triple therapy with a PPI (standard dose, bid), clarithromycin (500 mg, bid), and metronidazole (500 mg, bid)
Third-line therapy
Culture-guided therapy	10-day quadruple therapy comprising a PPI (standard dose, bid), bismuth (standard dose, qid), and two antibiotics selected by antimicrobial sensitivity tests
Levofloxacin-based quadruple therapy	PPI (standard dose, bid), bismuth (standard dose, qid), levofloxacin (500 mg, qd), and amoxicillin (500 mg, qid) for 10 days

Abbreviations: bid, twice daily; PPI, proton pump inhibitor; qd, once daily; qid, four times daily; tid, three times daily.

Table 2 Recommended regimens in countries with clarithromycin resistance

Regimen	Country	ITT			% clarithromycin resistance
		Eradication rate 14 days	Eradication rate 7 days	Eradication rate 10 days
PAC	Italy	57%–80%	82%	70%	≥20%
PAM	Italy	52%	–	56%	≥20%
PAC	Spain	86%	–	–	≥20%
PAC	Korea	71%	–	76%	≤20%
PCL	Italy	87%	–	–	≥20%
BAL	Spain	–	84%	–	≥20%
PAC	China	81%	–	–	≥20%
PBMT	Italy	–	91%	–	≥20%
PBMT	Spain	89%	–	–	≥20%
PBMT	China	83%	–	–	≥20%
PAMC	Taiwan	–	93%	–	≥20%
SeTrT	Italy	–	92%–94%	–	≥20%
SeTrT	China	–	89%	–	≥20%
SeTrT	Thailand	–	95%	–	≤20%
SeTrT	Korea	–	86%	–	≤20%

Abbreviations: P, proton pump inhibitor; A, amoxicillin; C, clarithromycin; M, metronidazole; L, levofloxacin; B, ranitidine bismuth citrate; M, metronidazole; T, tetracycline; ITT, intention to treat; SeTrT, sequential triple therapy.