Triple therapy for H. Pylori
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Helicobacter pylori triple therapy clarithromycin amoxicillin metronidazole duration 14 days guideline resistance
GradeResponse
H. pylori triple therapy (standard regimen):
- PPI (eg, omeprazole, esomeprazole, lansoprazole) BID
- Clarithromycin 500 mg BID
- Amoxicillin 1 g BID
- If penicillin allergy: replace amoxicillin with metronidazole 500 mg BID/TID
Duration: 14 days (preferred for higher eradication rates).
According to Treatment of Helicobacter pylori Infection (p. 9), clarithromycin triple therapy has declining success due to resistance, and bismuth quadruple therapy is often preferred first-line where clarithromycin resistance is common.
According to Treatment of Helicobacter pylori Infection (p. 9), clarithromycin triple therapy has declining success due to resistance, and bismuth quadruple therapy is often preferred first-line where clarithromycin resistance is common.
When to use clarithromycin triple therapy
Use only if:
- No prior macrolide exposure (eg, azithromycin/clarithromycin), and
- Local clarithromycin resistance is low (commonly <15%), or susceptibility is known.
Practical note
In many regions, bismuth quadruple therapy is now favored empirically over clarithromycin triple therapy because resistance rates are high.
If you want, I can give you a region-specific first-line regimen and salvage options after treatment failure.
If you want, I can give you a region-specific first-line regimen and salvage options after treatment failure.
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