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ACG : H. Pylori Infection Treatment Recommendations

ACG : H. Pylori Infection Treatment Recommendations

Helicobacter pylori (H. pylori) infection is an important cause of peptic ulcer disease and gastric cancer and is prevalent worldwide. While choosing a treatment regimen for H. pylori, patients should be asked about previous antibiotic exposure and this information should be incorporated into the decision-making process. The Guidelines have been published in American  Journal of  Gastroenterology.

Details regarding the drugs, doses, and duration of the recommended and suggested first-line and salvage regimens according to the guideline are as follows in tabular form.


Regimen Drugs/Dosing Duration (days)

Clarithromycin triple

PPI (standard or double dose twice daily) + clarithromycin (500mg twice daily) +amoxicillin (1g twice daily) or metronidazole (500mg three times daily)


Bismuth quadruple

PPI (standard dose twice daily) + bismuth subcitrate (120–300mg 4 times daily) or subsalicylate (300mg 4 times daily) + tetracycline (500mg 4 times daily) +metronidazole (250mg 4 times daily or 500mg 3–4 times daily)

10 –14


PPI (standard dose twice daily) + clarithromycin (500mg twice daily) + amoxicillin (1g twice daily) + nitroimidazole (500mg twice daily)

10 –14



PPI (standard dose twice daily) + amoxicillin (1g twice daily) followed by

5 –7

PPI + clarithromycin (500mg twice daily) + nitroimidazole (500mg twice daily)

5 –7


PPI (standard dose twice daily) + amoxicillin (1g twice daily) followed by


PPI + amoxicillin + clarithromycin (500mg twice daily) + nitroimidazole
(500mg twice daily)


Levofloxacin triple

PPI (standard dose twice daily) + levofloxacin (500mg daily) + amoxicillin
(1g twice daily)

10 –14

Levofloxacin sequential

PPI (standard or double dose twice daily) + amoxicillin (1g twice daily) followed by

5 –7

PPI + levofloxacin (500mg daily) + nitroimidazole (500mg twice daily)

5 –7


Levofloxacin (250mg daily) + omeprazole (double dose daily) + (Alnia)nitazoxanide (500mg twice daily) + doxycycline (100mg daily)

7 –10

References :

The American Journal of Gastroenterology volume112pages212–239 (2017) doi:10.1038/ajg.2016.563

Source: self

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