Version July 2025
| Regimen (United States brand names) | Drugs (doses) | Dosing frequency* | Duration (days) | Lowest retail price without prescription insurance (USD)¶ |
| Optimized bismuth quadruple (component therapy) | PPI standard doseΔ | Twice daily | 14 | Generics prescribed separately: $75◊ |
| Bismuth subsalicylate 300 or 524 mg§ or Bismuth subcitrate 120 to 300 mg (not available in United States) | 4 times daily | |||
| Tetracycline 500 mg¥ | ||||
| Metronidazole 500 mg | 3 or 4 times daily | |||
| Bismuth quadruple (as Pylera combination capsules plus PPI)‡ | PPI standard doseΔ | Twice daily | 10 | Pylera (generic): $189 Pylera (brand): $307 Plus standard-dose PPI (eg, esomeprazole): $15 |
| Fixed-dose combination capsules; 3 capsules deliver: bismuth subcitrate 420 mg, metronidazole 375 mg, and tetracycline 375 mg | 4 times daily | |||
| Rifabutin-amoxicillin-PPI triple (Talicia) | Fixed-dose combination capsules; 4 capsules deliver: omeprazole 40 mg, rifabutin 50 mg, and amoxicillin 1 g | 3 times daily | 14 | Talicia: $794 |
| Vonoprazan-amoxicillin dual (Voquezna Dual Pak) | Vonoprazan 20 mg | Twice daily | 14 | Voquezna Dual Pak: $824 |
| Amoxicillin 1 g | 3 times daily | |||
| Vonoprazan-amoxicillin-clarithromycin triple (Voquezna Triple Pak)† | Vonoprazan 20 mg | Twice daily | 14 | Voquezna Triple Pak: $789 |
| Amoxicillin 1 g | ||||
| Clarithromycin 500 mg |
BQT: bismuth quadruple therapy; PPI: proton pump inhibitor; USD: United States dollars.
* Antibiotics should be dosed with or shortly after meals.
¶ Lowest retail prices (USD) for 1 full treatment course without prescription insurance as listed on GoodRx website (accessed October 23, 2024). Prices will vary depending on insurance coverage.
Δ PPIs should be taken 30 to 60 minutes prior to meals. Standard doses of oral PPIs for treatment of H. pylori infection in treatment-naïve individuals include lansoprazole 30 mg twice daily, omeprazole 20 mg twice daily, rabeprazole 20 mg twice daily, or esomeprazole 20 mg twice daily. Pantoprazole 40 mg twice daily is a nonpreferred option due to its weaker acid inhibitory effect.
◊ Retail prices for tetracycline vary substantially.
§ In the United States, bismuth subsalicylate is available as a 262 mg chewable tablet. Bismuth subsalicylate should not be used in patients with salicylate allergy; bismuth subcitrate is an acceptable alternative.
¥ Doxycycline should not be substituted for tetracycline because doxycycline is associated with lower H. pylori eradication success.
‡ Helidac is a second BQT combination pill that contains bismuth subsalicylate 525 mg, tetracycline 500 mg, and metronidazole 250 mg taken 4 times daily. It is a nonpreferred option because it includes a suboptimal dose of metronidazole (the optimal dose of metronidazole is 1.5 to 2 g per day in divided doses).
† This regimen should be reserved for use in patients with documented clarithromycin-susceptible strains.
