A 42-year-old male presents with epigastric burning pain that improves with meals but awakens him at 2 AM. Endoscopy reveals a 1.2 cm duodenal ulcer, and a rapid urease test is positive. Which regimen is the recommended first-line eradication therapy?

Answer and explanation

Correct answer: C. Proton pump inhibitor, clarithromycin, amoxicillin (or metronidazole) for 14 days

  1. Step 1: A positive rapid urease test confirms Helicobacter pylori infection in duodenal ulcer disease.
  2. Step 2: First-line standard triple therapy consists of a proton pump inhibitor (PPI, e.g., omeprazole 20 mg BID), clarithromycin (500 mg BID), and amoxicillin (1000 mg BID, or metronidazole if penicillin-allergic) for 14 days.
Answer
Proton pump inhibitor, clarithromycin, amoxicillin (or metronidazole) for 14 days.
Why not the others: 'Omeprazole monotherapy' heals ulcers temporarily but leaves H. pylori active with high recurrence rates; 'Amoxicillin and ciprofloxacin' is not an approved first-line regimen; 'Ranitidine and sucralfate' provides acid suppression without bacterial eradication.

Practise more Internal Medicine and Therapeutics.

Free questions with an explanation for every one, and full timed Egyptian Medical Licensing Examination (EMLE) mock tests.

All Internal Medicine and Therapeutics questionsTake a mock test

More Internal Medicine and Therapeutics questions