Initial approach to antibiotic treatment for Helicobacter pylori infection

* In the United States, given the limited information on antimicrobial resistance rates, we generally assume clarithromycin resistance rates are ≥15% unless local data indicate otherwise.
¶ Alternative first-line antibiotic regimens include bismuth quadruple therapy and clarithromycin based concomitant therapy. Other potential treatment regimens include clarithromycin based sequential or hybrid therapy. However, hybrid therapy has not been universally endorsed as an option for first-line therapy and some North American guidelines do not support the use of sequential therapy. Refer to UpToDate topic on treatment regimens for H. pylori for additional details.