First-line Treatment

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Bismuth Quadruple Therapy (14 days)

40 mg esomeprazole b.i.d.

120 mg bismuth subcitrate q.i.d.

400 mg metronidazole t.i.d.

500 mg tetracycline q.i.d. (or 100 mg doxycycline b.i.d. if tetracycline is not available)

Note: Due to increased clarithromycin resistance, clarithromcyin triple therapy should be reserved for cases where pre-treatment antimicrobial susceptibilty testing is available and clarithromycin sensitivity confirmed. 

Please ensure there are no contraindications to any of the medications above.

Remember to schedule a post-eradication Urea breath test 4-6 weeks following completion of therapy. If the Urea breath test is unavailable, a stool antigen test may be used if locally validated.