What is the recommended dosage of Talicia (omeprazole, amoxicillin, and rifabutin) for the treatment of Helicobacter pylori (H. pylori) infection in adults?

Talicia Dosage for H. pylori Eradication

Talicia is dosed as omeprazole 40 mg, amoxicillin 1000 mg, and rifabutin 50 mg, taken every 8 hours (three times daily) for 14 days. 1

Specific Dosing Details

• Each dose consists of: omeprazole 40 mg + amoxicillin 1000 mg + rifabutin 50 mg 1
• Frequency: Every 8 hours (three times daily) 1
• Duration: 14 days 1
• Total daily doses: 3 doses per day 1

Administration Instructions

• Take Talicia at the start of meals to minimize gastrointestinal intolerance, as recommended for amoxicillin-containing regimens 2
• Timing: Administer every 8 hours consistently (e.g., 7 AM, 3 PM, 11 PM) 1
• Do not skip doses or take two doses at once if a dose is missed 3

Clinical Context and Efficacy

• Talicia achieved an 89.4% eradication rate in the ERADICATE Hp trial, significantly superior to both the 70% literature-derived comparator rate (P < 0.001) and the 63% standard-of-care rate (P = 0.006) 1
• This regimen is particularly valuable because rifabutin and amoxicillin resistance remain rare (<5%), making it effective even in areas with high clarithromycin and metronidazole resistance 4, 5
• Rifabutin-based triple therapy is recommended as a rescue option after failed first-line treatment by the American Gastroenterological Association 4, 5

Common Side Effects

• Most frequent adverse events (≥5%): diarrhea (12.7%), headache (11.9%), chromaturia/orange-red urine (9.3%), abdominal tenderness (6.8%), and dizziness (5.1%) 1
• No leukopenia was observed in clinical trials, addressing a theoretical concern with rifabutin use 1
• Compliance averaged 95% in the pivotal trial, suggesting the regimen is well-tolerated despite three-times-daily dosing 1

Important Clinical Considerations

• Rifabutin should be reserved for patients who have failed previous eradication attempts with other antibiotics, as recommended by the American Gastroenterological Association 5
• Do not use Talicia as first-line therapy unless bismuth quadruple therapy or concomitant therapy have failed or are contraindicated 4, 5
• The 14-day duration is mandatory—shorter courses have not been studied with this specific combination and would likely reduce efficacy 4, 5

Verification of Eradication

• Test for eradication at least 4 weeks after completing therapy using urea breath test or monoclonal stool antigen test 5
• Discontinue PPIs at least 2 weeks before testing to avoid false-negative results 5