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Guidelines for eradicating Helicobacter pylori infections (Gut 2007; 56:772 recommend standard triple therapy with omeprazole, clarithromycin, and amoxicillin (OCA) as first-line treatment, but rising clarithromycin resistance has eroded this regimen's effectiveness. In several trials conducted during the past decade, quadruple therapy with omeprazole plus a combined formulation of bismuth subcitrate potassium, metronidazole, and tetracycline (OBMT; Pylera) was more effective than standard OCA for patients with clarithromycin-resistant strains but was no more effective than OCA overall.
In a new manufacturer-sponsored European trial, investigators randomized 440 patients with confirmed H. pylori infections and upper gastrointestinal symptoms…