From the Guidelines
H. pylori quadruple therapy typically consists of a proton pump inhibitor (PPI) such as omeprazole 20mg twice daily, amoxicillin 1000mg twice daily, metronidazole 500mg twice daily, and clarithromycin 500mg twice daily, all taken for 14 days, as recommended by recent guidelines 1.
Key Components of Quadruple Therapy
- A proton pump inhibitor (PPI) to reduce stomach acid
- Amoxicillin to attack the bacteria
- Metronidazole to target the bacteria through a different pathway
- Clarithromycin to provide an additional antimicrobial effect
Duration and Dosage
The recommended duration of quadruple therapy is 14 days, with the following dosages:
- PPI: 20mg twice daily (e.g., omeprazole)
- Amoxicillin: 1000mg twice daily
- Metronidazole: 500mg twice daily
- Clarithromycin: 500mg twice daily
Rationale for Quadruple Therapy
Quadruple therapy is effective because it targets H. pylori through multiple mechanisms, reducing the chance of resistance and improving eradication rates, as supported by recent guidelines 1.
Important Considerations
- Patients should complete the full course of treatment even if symptoms improve
- Avoid alcohol while taking metronidazole to prevent disulfiram-like reactions
- The choice of quadruple therapy regimen may depend on factors such as antibiotic resistance patterns and patient tolerance, with the concomitant non-bismuth quadruple therapy being a recommended first-line option 1
From the Research
H. Pylori Quadruple Therapy Components
- The components of H. pylori quadruple therapy may vary, but common regimens include:
- A proton pump inhibitor (PPI) such as omeprazole or pantoprazole
- Two antibiotics, such as amoxicillin and clarithromycin
- Bismuth potassium citrate or another bismuth-containing compound 2
- Alternatively, quadruple therapy may consist of a PPI, amoxicillin, clarithromycin, and a nitroimidazole 3
- Other regimens may include different antibiotics, such as levofloxacin, rifabutin, or furazolidone, in combination with a PPI and other agents 4, 5
Specific Regimens
- One study found that a 14-day regimen of omeprazole, amoxicillin, clarithromycin, and bismuth potassium citrate was effective in eradicating H. pylori 2
- Another study compared 10-day and 14-day regimens of pantoprazole, amoxicillin, clarithromycin, and a nitroimidazole, and found that the 10-day regimen was highly efficacious and better tolerated 3
- A network meta-analysis found that a regimen of rabeprazole, bismuth, furazolidone, and tetracycline had the highest eradication rate, while a regimen of lansoprazole, bismuth, amoxicillin, and clarithromycin had the best safety profile 6