Clarithromycin resistance above about 15% makes standard triple therapy unreliable, and resistance in India is widely reported well above that level.
For first-line treatment, choose bismuth quadruple therapy (a PPI, bismuth, tetracycline and metronidazole) for 14 days, or use susceptibility-guided therapy where molecular testing is available. Ask about previous macrolide use, including azithromycin for respiratory infections, which raises the chance of resistance.
Always confirm eradication with a urea breath test or stool antigen test at least four weeks after treatment and two weeks off PPIs. A failed first course makes the second harder.
- Ask about previous macrolide use before choosing a regimen
- Use 14-day bismuth quadruple therapy first line where resistance is unknown or high
- Use susceptibility testing where available
- Confirm eradication at least 4 weeks after treatment, off PPIs for 2 weeks
Why it matters
Most H. pylori treatment failures come from choosing clarithromycin without knowing resistance.
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