What is sequential nonbismuth quadruple therapy for the eradication of Helicobacter pylori infection?

Updated: Dec 09, 2020
  • Author: Joseph Adrian L Buensalido, MD; more...
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Sequential therapy (a suggested first-line option [2] ) is superior to standard triple therapy, according to two systematic reviews, [12, 13] and consists of the following:

  1. PPI plus amoxicillin for 5-7 days (eg, pantoprazole 40 mg BID and amoxicillin 1 g BID for 7 days [14] ), then

  2. PPI plus 2 other antibiotics for the next 5-7 days; clarithromycin and metronidazole are the antibiotics usually chosen, but levofloxacin-based regimens (see below) [12, 15, 16] and tetracycline-based regimens (eg, pantoprazole 40 mg BID, tetracycline 500 mg QID, and metronidazole 500 mg BID) [14] are superior to 14-day triple therapy, based on a meta-analysis of 21 trials [12]

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