Best Antibiotics for H. Pylori

Helicobacter pylori is a common stomach bacterium linked to peptic ulcers and, less commonly, stomach cancer — but treating it is never as simple as "take this one antibiotic." Because a single antibiotic reliably fails to fully eradicate it and resistance is a real, growing problem, H. pylori treatment always combines two or more antibiotics with an acid-suppressing drug (a proton pump inhibitor), taken together for 10–14 days.

The traditional first-line option, triple therapy — a PPI plus amoxicillin and clarithromycin — has become less reliable in many regions as clarithromycin resistance has risen, and current guidelines increasingly favor quadruple therapy instead: a PPI, bismuth subsalicylate, metronidazole, and tetracycline, taken together. Which regimen gets used often depends on local resistance patterns and whether someone has been on a macrolide antibiotic (like azithromycin or clarithromycin) recently for anything else, which raises the odds triple therapy will fail. Levofloxacin-based regimens are a common second-line option when first-line treatment doesn't clear the infection.

Because partial treatment can drive resistance and make the next attempt harder, completing the entire multi-drug course matters more here than with almost any other infection covered on this site. Confirming the infection is actually gone — with a breath, stool, or endoscopic test done at least four weeks after finishing antibiotics and after stopping the PPI for a period — is a standard, important step that's easy to skip but shouldn't be.