Treatment of Helicobacter pylori infection: Current status and future concepts

Table 1 Treatment regimens proposed for the management of Helicobacter pylori infection in different geographic areas

Treatment	Asia-Pacific region[13]	Developing countries[14]	Europe[15]	United States[16]
First-line	Triple therapy	Triple therapy	Triple therapy	Triple therapy
	(PPI + CLA + AMO/MET)	(PPI + CLA + AMO/FUR)	(PPI-CLA-containing regimen)	(PPI + CLA + AMO/MET)
	BIS-based quadruple therapy	Quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy
	(PPI + BIS + MET + TET)	(PPI + CLA + AMO + BIS/MET or PPI + BIS + MET + TET)	(for high clarithromycin resistance)	(BIS + MET + TET + RAN)
			Sequential therapy	Sequential therapy
		Sequential therapy	(for high clarithromycin resistance)	(PPI + AMO and PPI + CLA + TIM)
		(PPI + AMO and PPI + CLA + NIT)
Second-line	BIS-based quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy	BIS-based quadruple therapy
	(PPI + BIS + MET + TET)	(PPI + BIS + TET + MET/FUR)	LEV-based triple therapy	(PPI + TET + BIS + MET)
	LEV-based triple therapy	LEV-based triple therapy:		LEV-based triple therapy
	(PPI + LEV + AMO)	(PPI + LEV + BIS/FUR/AMO)		(PPI + AMO + LEV)
	RIF-based triple therapy
	(PPI + RIF + AMO)
Third-line	RIF-based triple therapy	LEV-based or FUR-based triple therapy	Guided by antimicrobial susceptibility testing
	(PPI + RIF + AMO)	(PPI + AMO + LEV/RIF or
		PPI + FUR + LEV)

AMO: Amoxicillin; BIS: Bismuth; CLA: Clarithromycin; FUR: Furazolidone; LEV: Levofloxacin; MET: Metronidazole; NIT: Nitronidazole; RAN: Ranitidine; RIF: Rifabutin; TET: Tetracycline; TIM: Timidazole; PPI: Proton pump inhibitor.