Triple therapy with an anti-secretary agent (preferably a PPI) + 2 antibiotics (clarithromycin and amoxicillin or metronidazole) for 14 days.

Quadruple therapy due to recent failrues with triple therapy. Would be a PPI plus bismuth, metronidazole, and tetracycline for 10 - 14 days (can use Helidac or Pylera).

Sequential Therapy: a PPI with amoxicillin for 5 days, followed by a PPI with clarithromycin and tinidazole for 5 days.

Do not make substitutions in H. pylori eradication regimens. Histamine2 - receptor blockers should not be substituted for a PPI. Likewise, other antibiotics in the same class should not be substituted in H. pylori eradication regimens (for example, do not use ampicillin instead of amoxicillin).

caution with concurrent use of itraconazole, ketoconazole, calcium carbonate and iron due to reduced absorption from increased pH.

2C19; may prevent conversion of clopidogrel to active form

3A4 major inhibitor

can chelate (complex) with aluminum, magnesium, calcium, iron and zinc leading to decrased drug absorption. The administration time must be seperated (2 hours before and 2 hours after, usually)

Counseling: If taking bismuth subsalicylate, the pink tablets are chewable while the other medications are swallowed. If taken with aspirin and ringing in the ears occurs, contact your doctor. Counsel on symptoms of bleeding. Bismuth subsalicylate may cause temporary and harmless darkening of the tongue and/or black stool.

Do not use if pregnant or in children less than or equal to 8 years of age. Oral contraceptive may be less effective. Use a back-up form of contraception, such as condoms, during antibiotic therapy. This medication will make your skin more sensitive to the sun and you may burn more easily. Use sunscreen.

take additional PPI (Pylera) or Histamine - 2 blocker (Helidac) for entire course of therapy, as directed. The histamine - 2 blocker is recommended for an additional 14 days after the end of Helidac therapy.