H. pylori Salvage Tx Regimens, Adult

Bismuth quadruple

[14 day regimen]

[metronidazole 500 mg PO tid-qid] + [tetracycline 500 mg PO qid] + [bismuth subcitrate 120-300 mg PO qid OR bismuth subsalicylate 262-525 mg PO qid] + [PPI standard dose PO bid (see options below)]

Levofloxacin triple

[14 day regimen]

[amoxicillin 1 g PO bid] + [levofloxacin 500 mg PO qd] + [PPI standard dose PO bid (see options below)]

Concomitant

[10-14 day regimen]

[amoxicillin 1 g PO bid] + [clarithromycin 500 mg PO bid] + [metronidazole 500 mg PO bid-tid OR tinidazole 500 mg PO bid-tid] + [PPI standard dose PO bid (see options below)]

Rifabutin triple

[10 day regimen]

[amoxicillin 1 g PO bid] + [rifabutin 300 mg PO qd] + [PPI standard dose PO bid (see options below)]

High-dose dual

[14 day regimen]

[amoxicillin 1 g PO tid or 750 mg PO qid] + [PPI standard dose PO tid-qid OR PPI double dose PO tid-qid (see options below)]

PPI options

[standard doses bid]

dexlansoprazole 30 mg bid; esomeprazole 20 mg bid (alt: 40 mg qd); esomeprazole strontium 24.65 mg bid (alt: 49.3 mg qd); lansoprazole 30 mg bid; omeprazole 20 mg bid; pantoprazole 40 mg bid; rabeprazole 20 mg bid

[standard doses tid-qid]

dexlansoprazole 30 mg tid-qid; esomeprazole 20 mg tid-qid; esomeprazole strontium 24.65 mg tid-qid; lansoprazole 30 mg tid-qid; omeprazole 20 mg tid-qid; pantoprazole 40 mg tid-qid; rabeprazole 20 mg tid-qid

[double doses tid-qid]

dexlansoprazole 60 mg tid-qid; esomeprazole 40 mg tid-qid; esomeprazole strontium 49.3 mg tid-qid; lansoprazole 60 mg tid-qid; omeprazole 40 mg tid-qid; pantoprazole 80 mg tid-qid; rabeprazole 40 mg tid-qid

Avail. Prepackaged

omeprazole and clarithromycin and amoxicillin avail. prepackaged as OmeClamox-Pak (10 day supply); lansoprazole and amoxicillin and clarithromycin avail. prepackaged as Prevpac (14 day supply); bismuth subsalicylate and metronidazole and tetracycline avail. prepackaged (14 day supply); bismuth subcitrate potassium/metronidazole/tetracycline avail. prepackaged as Pylera (10 day supply)