In quadruple therapy, the following oral medications are given for 14 days (4): A proton pump inhibitor (lansoprazole 30 mg 2 times a day, omeprazole 20 mg 2 times a day, pantoprazole 40 mg 2 times a day, rabeprazole 20 mg 2 times a day, or esomeprazole 40 mg once a day) Bismuth subsalicylate 524 mg 4 times a day Metronidazole 250 mg 4 times a day Tetracycline 500 mg 4 times a day In regions where H pylori clarithromycin resistance is known to be < 15% and in patients with no previous history of macrolide exposure, triple therapy with the following oral medications for 14 days remains an initial treatment option (2, 3): A proton pump inhibitor (lansoprazole 30 mg 2 times a day, omeprazole 20 mg 2 times a day, pantoprazole 40 mg 2 times a day, rabeprazole 20 mg 2 times a day, or esomeprazole 40 mg once a day) Amoxicillin 1 g 2 times a day or metronidazole 250 mg 4 times a day Clarithromycin 500 mg 2 times a day If quadruple therapy fails, the European guidelines suggest dual therapy with a high-dose PPI and amoxicillin or triple therapy with a PPI, amoxicillin, and a fluoroquinolone (2).