Possible future regimens for Helicobacter pylori
| Likely effective but not yet optimized empiric regimens |
| Hybrid (sequential-concomitant) therapy Both of the following twice a day for 7 days: Amoxicillin 1 g A proton pump inhibitor Followed by all of the following twice a day for a further 7 days (total 14 days): Amoxicillin 1 g Clarithromycin 500 mg Tinidazole 500 mg or metronidazole 500 A proton pump inhibitor b |
| New bismuth quadruple therapy (amoxicillin replaces tetracycline)23 All of the following for 14 days: Bismuth 2 tablets 2 to 4 times daily with meals and at bedtime Metronidazole or tinidazole 500 mg 3 times daily (or 400 mg 4 times daily) with meals Amoxicillin 1 g 3 times daily A proton pump inhibitor twice daily for 14 days b |
| Rifabutin triple therapy33 All of the following for 14 days: Rifabutin 150 mg once or twice daily Amoxicillin 1.5 g twice daily Omeprazole 20 mg (or an equivalent) every 8 hours |
| Rifabutin-bismuth therapy34 All of the following twice daily for 14 days: Rifabutin 150 mg Bismuth subcitrate or subsalicylate 2 tablets Amoxicillin 1 g A proton pump inhibitor b |
| Possible future regimens |
| High-dose proton pump inhibitor-amoxicillin dual therapy (effective for CYP2C19 poor metabolizers—see text) Both of the following at approximately 6-hour intervals for 14 days (can use 8-hour intervals at night): A proton pump inhibitor (eg, rabeprazole 40 mg or esomeprazole 40 mg) Amoxicillin 500-750 mg |
| Vonoprazan-amoxicillin dual therapy Both of the following for 14 days: Vonoprazan 20 mg twice a day Amoxicillin 500 mg every 6 hours for 14 days |
a These therapies are not yet optimized to reliably achieve > 90% or preferably > 95% cure rates.
↵b Preferred proton pump inhibitors are omeprazole 40 mg, lansoprazole 45 or 60 mg, rabeprazole 20 mg, or esomeprazole 20 mg; pantoprazole is not recommended as 40 mg is approximately equivalent to 9 mg omeprazole.