A 45-year-old male presents with recurrent episodes of severe epigastric burning pain that awakens him at night and improves temporarily after eating. Stool antigen test confirms Helicobacter pylori infection. What is the standard quadruple eradication regimen?

Answer and explanation

Correct answer: A. PPI, Bismuth subsalicylate, Metronidazole, and Tetracycline

  1. Step 1: Bismuth quadruple therapy (PPI twice daily, Bismuth subsalicylate, Metronidazole, and Tetracycline for 14 days) is the recommended first-line regimen for H. pylori.
  2. Step 2: This regimen achieves high eradication rates even in regions with substantial clarithromycin resistance.
Answer
PPI, Bismuth subsalicylate, Metronidazole, and Tetracycline.
Why not the others: 'Amoxicillin and Clarithromycin alone without acid suppression' fails because antibiotics require reduced gastric acidity to remain active; 'PPI and Ciprofloxacin for 5 days' is not an approved first-line regimen; 'High-dose antacids and oral sucralfate' provide symptomatic relief but cannot eradicate H. pylori.

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