bismuth subcitrate potassium/ metronidazole/tetracycline / Generic mfg. - LARVOL DELTA

VI Spanish Consensus Conference on the treatment of Helicobacter pylori infection. (PubMed, Gastroenterol Hepatol) - "As first-line treatment, a 10-day regimen with a proton pump inhibitor plus bismuth, tetracycline, and metronidazole (Pylera®) is recommended. After failure of this regimen, a combination of a proton pump inhibitor, amoxicillin, levofloxacin, and bismuth is recommended. This consensus also provides a detailed review of other rescue treatment alternatives."

Clinical guideline • Journal • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Oncology • Peptic Ulcer • Solid Tumor

VI Spanish Consensus Conference on the treatment of Helicobacter pylori infection. (PubMed, Rev Esp Enferm Dig) - "As first-line treatment, a 10-day regimen with a proton pump inhibitor plus bismuth, tetracycline, and metronidazole (Pylera®) is recommended. After failure of this regimen, a combination of a proton pump inhibitor, amoxicillin, levofloxacin, and bismuth is recommended. This consensus also provides a detailed review of other rescue treatment alternatives."

Journal • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Oncology • Peptic Ulcer • Solid Tumor

EFFECTIVENESS AND SAFETY OF SINGLE-CAPSULE BISMUTH QUADRUPLE THERAPY IN 16,000 PATIENTS FROM THE EUROPEAN REGISTRY ON HELICOBACTER PYLORI MANAGEMENT (HP-EUREG) (UEGW 2026) - "Aims & To assess the effectiveness and safety of the three-in-one single-capsule (Pylera®) therapy for Helicobacter pylori (H... In real-world European practice, the 10-day single-capsule bismuth quadruple therapy achieved H. pylori eradication in over 90% of treatment-naïve patients, with a favourable safety profile. Although effectiveness decreased in rescue settings, therapy success increased in compliant patients and in those receiving higher PPI doses, underscoring the importance of adequate treatment selection and patient adherence."

Clinical • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Peptic Ulcer

REAL-WORLD EFFECTIVENESS OF FIRST-LINE HELICOBACTER PYLORI THERAPIES IN GERMANY: ERADICATION OUTCOMES IN A LOW CLARITHROMYCIN-RESISTANCE SETTING USING DATA FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG) (UEGW 2026) - "Clarithromycin-amoxicillin triple therapy (Triple-CA, 53%) and bismuth-metronidazole-tetracycline quadruple therapy in the single-capsule formulation (Pylera®, 43%) were the predominant first-line regimens. In Germany, empirical first-line H. pylori therapy achieves excellent eradication rates when optimized 10-day regimens are used. Comparable outcomes between Triple-CA and Pylera® may be explained by the relatively low clarithromycin resistance rates reported in Germany. Beyond dyspepsia and peptic ulcer disease, GC prevention already represents a relevant indication in German routine clinical practice."

Clinical • Real-world • Real-world effectiveness • Real-world evidence • Dyspepsia • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Peptic Ulcer • Solid Tumor

OUTCOMES OF FIRST-LINE EMPIRICAL HELICOBACTER PYLORI ERADICATION THERAPY IN AUSTRIA: DATA FROM THE EUROPEAN REGISTRY ON THE MANAGEMENT OF H. PYLORI INFECTION (HP-EUREG) (UEGW 2026) - "The most commonly prescribed regimens, all combined with a proton pump inhibitor (PPI), were non-bismuth quadruple concomitant therapy with amoxicillin, clarithromycin and metronidazole (concomitant-ACM) (70%), three-in-one single-capsule therapy (Pylera®), consisting of bismuth, tetracycline, and metronidazole (16%), and standard triple therapy with amoxicillin and clarithromycin (triple-AC) (5%)...PPIs were administered at low (4.5 to 27 mg omeprazole equivalents b.i.d.), standard (32 to 40 mg omeprazole equivalents b.i.d.), and high doses (54 to 128 mg omeprazole equivalents b.i.d.) in 88%, 5%, and 7%, respectively... In Austria, concomitant-ACM and Pylera® achieved optimal eradication rates (≥90%) in a real-world clinical setting, supporting their continued use as empirical first-line options. Treatment duration appeared to have a greater impact on eradication success than PPI dose. As antibiotic resistance rates continue to rise worldwide, regular..."

Clinical • Dyspepsia • Gastric Cancer • Infectious Disease • Peptic Ulcer • Solid Tumor

EFFECTIVENESS OF REUSE OF HELICOBACTER PYLORI ERADICATION THERAPIES AFTER PRIOR FAILURE: RESULTS FROM THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG) (UEGW 2026) - "The most frequently reused therapies were triple therapy with amoxicillin-clarithromycin (Triple-CA), quadruple concomitant therapy with clarithromycin-amoxicillin-metronidazole (Conco-CAM), and bismuth-containing quadruple therapies with clarithromycin-amoxicillin (Quad-CAB) and metronidazole-tetracycline, either as a single-capsule formulation (Pylera®) or as a classical formulation. In real-world European clinical practice, repeated use of bismuth-containing quadruple therapies in 2nd line rescue therapy achieved relatively high eradication rates, particularly with longer treatment durations (10-14 days). Empirical reuse of these regimens may be considered when alternative options are unavailable or not feasible."

Infectious Disease

HELICOBACTER PYLORI EMPIRICAL FIRST-LINE AND RESCUE TREATMENT EFFECTIVENESS IN PATIENTS ALLERGIC TO PENICILLIN: EXPERIENCE AMONG 2,700 CASES OF THE EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG) (UEGW 2026) - "However, bismuth quadruple therapy with tetracycline-metronidazole, either as a single-capsule formulation (Pylera®) or as a traditional regimen (Quad-MTcB), is increasingly recommended...In second-line therapy, the most commonly used regimens were the single-capsule (29%), and triple therapies with clarithromycin-levofloxacin (16%), and with metronidazole-levofloxacin (10%), showing heterogeneous effectiveness (86%, 74%, and 67%, respectively; p<0.01), generally lower than in first-line therapy but remaining high for bismuth-based quadruple therapies... In patients allergic to penicillin, Triple-CM should not be used as first-line therapy due to its lower effectiveness compared with bismuth quadruple regimens. Bismuth quadruple therapy, particularly with the single-capsule formulation, achieves high eradication rates and is the preferred first-line option. Treatment effectiveness decreases in subsequent lines, with bismuth-based quadruple regimens remaining the..."

Clinical • Dyspepsia • Gastroenterology • Gastrointestinal Disorder • Immunology • Infectious Disease • Peptic Ulcer

REAL-WORLD OUTCOMES OF FIRST-LINE HELICOBACTER PYLORI ERADICATION THERAPY: IMPACT OF REGIMEN CHOICE AND COMPLIANCE IN SINGAPORE (UEGW 2026) - "Guideline-concordant regimens (PAC, PBMT [PPI, bismuth, metronidazole, tetracycline], PBAC [PPI, bismuth, amoxicillin, clarithromycin], VAC [vonoprazan, amoxicillin, clarithromycin]) were compared with guideline-non-concordant regimens. Empirical first-line H. pylori eradication in Singapore continued to achieve acceptable real-world outcomes, but PAC efficacy had fallen modestly since the prior audit, likely reflecting rising clarithromycin resistance. While PAC remained widely used, alternative regimens such as PBMT and PBAC demonstrated comparable or higher success rates and may warrant broader uptake. Reinforcing 14-day, guideline-concordant therapy, improving adherence, and considering susceptibility-guided strategies will be key to sustaining high eradication rates in the local setting."

Clinical • Compliance • Real-world • Real-world evidence • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Infectious Disease • Peptic Ulcer • Solid Tumor

Pylori Duo for Adjunctive Treatment and Prevention of Recurrence of Helicobacter Pylori Infection (clinicaltrials.gov) - P=N/A | N=140 | Not yet recruiting | Sponsor: Gala Servicios Clinicos S.L.

New trial • Dyspepsia • Infectious Disease

Higher doses of Bismuth and antibiotics do not improve H. pylori treatment effectiveness: results from the Hp-EuReg. (PubMed, Clin Gastroenterol Hepatol) - "Increasing antibiotic or bismuth doses above the standard did not improve effectiveness of H. pylori treatment. Adherence, treatment length, and proton pump inhibitor co-therapy may be more impactful than escalation of antibiotics/bismuth doses."

Journal • Infectious Disease

Review Article: Classic Bismuth Quadruple Therapy for Helicobacter pylori Infection-Questions Focused on Clinical Practice. (PubMed, Aliment Pharmacol Ther) - "BQT remains the most effective, safe, and practical regimen for H. pylori eradication, ensuring high cure rates across diverse resistance patterns and clinical settings. Simplified formulations further improve convenience and adherence, reinforcing its role as a globally applicable therapy."

Journal • Review • Allergy • Immunology • Infectious Disease

Assessing Helicobacter pylori Testing and Treatment by Providers at an Academic Tertiary Medical Center: A Quality Improvement Project (ACG 2025) - "To assess baseline knowledge, in 2018 we performed an IRB approved survey of primary care and GI providers and found 20% were considering serology as a diagnostic option, 50% were treating asymptomatic patients with HPI, 15% were primarily treating with PPI-Bismuth-Metronidazole-Tetracycline (PBMT), 38% were always checking for eradication and 98% said local resistance information for HPI would be helpful. 108 providers participated in the re-assessment survey (Table 1). Key results include that 8% of providers are using serology for diagnosis, 69% are treating asymptomatic patients with HPI, 81% primarily prescribe PBMT and 78% always tested for eradication (Table 2). 14 % of providers are primarily prescribing PPI-amoxicillin-clarithromycin (PAC). Compared to 2018, 5 times more providers are primarily prescribing PBMT and almost 2 times more are consistently testing for eradication, likely as a result of updated national guidelines and local educational and..."

Infectious Disease • Pediatrics

Effectiveness of First-Line Empirical Treatment in Portugal: Data from the European Registry on Helicobacter pylori Management. (PubMed, GE Port J Gastroenterol) - "Conversely, both quadruple concomitant PPI-clarithromycin-amoxicillin-metronidazole and PPI-bismuth-metronidazole-tetracycline therapies were predominantly used from 2016 onwards, with PPI-bismuth-metronidazole-tetracycline representing 76% of all prescriptions in 2022, achieving an overall mITT effectiveness of 92% and 91%, respectively. In Portugal, concomitant quadruple therapy with PPI-clarithromycin-amoxicillin-metronidazole and bismuth quadruple with PPI-bismuth-metronidazole-tetracycline provided both optimal (>90%) effectiveness, in line with results of other Southern European countries."

Journal • Gastric Cancer • Infectious Disease • Oncology • Solid Tumor

VONOPRAZAN IS HIGHLY EFFECTIVE AND SAFE AS AN ADJUVANT IN DIFFERENT REGIMENS IN FIRST- AND RESCUE-LINE THERAPIES FOR H. PYLORI INFECTION IN BRAZIL (UEGW 2025) - "Low-dose (between 4.5 and 27mg of omeprazole equivalent BID), standard-dose (between 32 and 40mg of omeprazole equivalent BID), and high-dose (between 54 and 128mg of omeprazole BID) of proton pump inhibitor (PPIs) as well as 20mg BID of vonoprazan (VPZ) were used in 39%, 38%, 23%, and 15% of treatment cases, respectively...The regimens reaching 90% eradication were: dual-VPZ+amoxicillin for first-line and rescue treatments (96% and 100%, respectively), quadruple VPZ+bismuth+tetracycline+metronidazole for second- and third-line treatments (92% and 90% respectively), and quadruple PPI+bismuth+levofloxacin+amoxicillin (100%) for second-line treatment... VPZ, when prescribed as an adjuvant for treating H. pylori infection, shows highly effective results as part of dual therapy with amoxicillin for first-line and rescue treatments, as well as in quadruple therapy with bismuth+metronidazole+ tetracycline or bismuth+amoxycillin and rifabutin for rescue treatments."

Clinical • Dyspepsia • Infectious Disease • Peptic Ulcer

EFFECTIVENESS OF 10-DAY COMBINATION THERAPY IN A EUROPEAN PILOT GASTRIC CANCER SCREENING PROGRAMME: INTERIM RESULTS (UEGW 2025) - "Aims & This interim data evaluates the efficacy of 10-day treatment with single capsule combination therapy: Bismuth subcitrate 140mg/Metronidazole 125mg/Tetracycline 125mg, three tablets, four times daily (PYLERA, Juvise pharmaceuticals) with a high-dose proton pump inhibitor (Esomeprazole 40mg twice daily).Secondary outcome measures include; Treatment acceptance rateSide-effect profileAdverse events3030 individuals aged 30-34 years were invited to undergo screening for H. pylori through their general practitioner or workplace in the period January 24-March 25...In those requiring 2nd line therapy (n=4), levofloxacin-based quadruple therapy was found to be successful in 66%(2/3) of those who completed eradication follow-up... Single capsule combination therapy and high-dose PPI achieved eradication rates of >90% in the per-protocol group. No serious adverse events occurred secondary to treatment. These interim results indicate that 10-day combination therapy..."

Combination therapy • Gastric Cancer • Infectious Disease • Oncology • Solid Tumor

HELICOBACTER PYLORI ERADICATION PRESCRIPTIONS IN PRIMARY CARE: INSIGHTS FROM OVER 200,000 PATIENTS IN A NATIONAL REAL-WORLD COHORT (UEGW 2025) - "The most frequent first-line treatments included: proton pump inhibitor (PPI) plus a single-capsule containing bismuth, tetracycline and metronidazole (Pylera®) (PPI+ScBQT) with 36% of cases; PPI, clarithromycin, amoxicillin (PPI+C+A) with 30%; and the combination PPI, clarithromycin, amoxicillin, metronidazole (PPI+C+A+M), with 26%. H. pylori eradication treatments in Primary Care are heterogeneous, with single-capsule bismuth quadruple therapy being the most prescribed. The use of first-line treatment guidelines has generally aligned with Spanish and European recommendations, although their adoption in Primary Care has been slower than in Specialised Care."

Clinical • Real-world • Real-world evidence • Chronic Kidney Disease • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Infectious Disease • Nephrology • Obesity • Peptic Ulcer • Renal Disease • Solid Tumor

EFFECTIVENESS OF HELICOBACTER PYLORI ERADICATION TREATMENTS IN PRIMARY CARE: INSIGHTS FROM A NATIONAL REAL-WORLD COHORT (UEGW 2025) - "The most frequently prescribed first-line regimen in both Primary and Specialised Care was proton pump inhibitor plus a single-capsule with bismuth, tetracycline and metronidazole (Pylera®) (PPI+ScBQT)...PPI+ScBQT had the highest eradication rate (91%), followed by PPI + clarithromycin (C) + amoxicillin (A) + metronidazole (M) (88%), PPI+C+A (70%), and PPI+C+M (61%)... In the Primary Care setting, single-capsule bismuth quadruple therapy showed the highest effectiveness, followed by non-bismuth concomitant quadruple therapy (PPI+C+A+M). These results were consistent with those reported in the Gastroenterology setting."

Clinical • Real-world • Real-world evidence • Chronic Kidney Disease • Gastric Cancer • Gastroenterology • Gastrointestinal Disorder • Genetic Disorders • Infectious Disease • Nephrology • Obesity • Peptic Ulcer • Renal Disease • Solid Tumor

A PRIMARY PREVENTATIVE GASTRIC CANCER SCREENING APPROACH IN A WESTERN EUROPEAN COUNTRY: INTERIM RESULTS OF THE IRISH EXPERIENCE (UEGW 2025) - "Positive participants were offered treatment with a 10-day regimen of single capsule combination therapy (Bismuth subcitrate 140mg/Metronidazole 125mg/Tetracycline 125mg, three tablets, QDS; PYLERA, Juvise pharmaceuticals) + Esomeprazole 40mg BD. These interim results indicate that a population-based H.pylori screening approach is feasible within an Irish population. Despite a decreasing worldwide prevalence, infection remains a persistent issue. Although initial response rates to screening are modest, this is a novel pilot programme and reflects trends seen in the early phases of other national screening programmes, such as the colorectal cancer screening."

Colorectal Cancer • Gastric Cancer • Infectious Disease • Oncology • Solid Tumor

TARGETED VERSUS POPULATION-BASED SCREENING AS A PRIMARY PREVENTIVE APPROACH TOWARDS GASTRIC CANCER: INTERIM RESULTS OF THE IRISH EXPERIENCE (UEGW 2025) - "Confirmed cases were offered a 10-day regimen of PYLERA (Metronidazole/Tetracycline/Bismuth subcitrate) with Esomeprazole 40 mg BD. Targeted occupational screening in high-risk populations demonstrated superior response and engagement rates compared to general practice-based screening. These early results suggest this approach may be a more effective and resource-conscious strategy in low-to-intermediate risk countries and merit further evaluation in broader implementation efforts."

Clinical • Gastric Cancer • Infectious Disease • Oncology • Solid Tumor

Comparative Effectiveness of Empiric Treatment for Helicobacter pylori in a Large, Diverse Population in the United States. (PubMed, Clin Gastroenterol Hepatol) - "In a large, community-based U.S. population, concomitant and bismuth-quadruple therapies had the highest eradication rates for H. pylori for initial treatment without a substantial decline in efficacy over time, while bismuth quadruple was the most successful salvage regimen. History of macrolides or metronidazole use should be reviewed to inform treatment selection. Repeat use of previously prescribed regimens should be avoided."

HEOR • Journal • Infectious Disease

Investigating the Effect of eradication of Helicobacter Pylori Infection in Controlling Blood Sugar in Diabetic Patients. (PubMed, Arch Razi Inst) - "In this experimental study, 61 type II diabetic patients with or without dyspepsia symptoms, in whom Helicobacter pylori infection was proven by anti-Helicobacter pylori IgG serological method, were treated with four anti-Helicobacter pylori drug regimens (bismuth+ metronidazole) +tetracycline + omeprazole. It was concluded that a positive relationship exists between the eradication effect of Helicobacter pylori and blood sugar control (reduction of HbAlC). However, further studies in diabetic patients are recommended to obtain more accurate results."

Journal • Diabetes • Dyspepsia • Infectious Disease • Metabolic Disorders • Type 2 Diabetes Mellitus

VONOPRAZAN IS HIGHLY EFFECTIVE AND SAFE AS AN ADJUVANT IN DIFFERENT REGIMES IN FIRST- AND RESCUE-LINE THERAPIES FOR H. PYLORI INFECTION IN BRAZIL (DDW 2025) - "The regimens reaching 90% eradication were: dual-VPZ+amoxicillin for first-line and rescue treatments (96% and 100%, respectively), quadruple VPZ+bismuth+tetracycline+metronidazole for second- and third-line treatments (92% and 90% respectively), and quadruple PPI+bismuth+levofloxacin+amoxicillin (100%) for second-line treatment (Table and Figure). VPZ, when prescribed as an adjuvant for treating H. pylori infection, shows highly effective results as part of dual therapy with amoxicillin for first-line and rescue treatments, as well as in quadruple therapy with bismuth+metronidazole+ tetracycline or bismuth+amoxycillin and rifabutin for rescue treatments."

Clinical • Dyspepsia • Gastric Cancer • Gastroenterology • Infectious Disease • Peptic Ulcer

Tailored Vs. Empirical Helicobacter Pylori Infection Treatment (clinicaltrials.gov) - P4 | N=160 | Not yet recruiting | Sponsor: Manuel Coelho da Rocha | Trial completion date: Nov 2025 ➔ Dec 2026 | Trial primary completion date: Jun 2025 ➔ Sep 2026

Trial completion date • Trial primary completion date • Infectious Disease

THE INFLUENCE OF INDICATIONS FOR HELICOBACTER PYLORI INVESTIGATION ON PRESCRIPTIONS AND EFFECTIVENESS: EUROPEAN REGISTRY ON H. PYLORI MANAGEMENT (HP-EUREG) (UEGW 2024) - "The effectiveness with PPI-bismuth-metronidazole-tetracycline (quadruple-BMTc) was lower in patients treated for non-investigated dyspepsia as compared to those with dyspepsia with normal endoscopy, however, in all cases cure rates were optimal (91.8% vs. 93.9%, p= 0.047)...Concomitant clarithromycin-amoxicillin-tinidazole/metronidazole (CAT-CAM) achieved 90% except in patients with non-investigated dyspepsia... In Europe, indications for H. pylori investigation could be improved in 5.6% of patients. Higher effectiveness was observed in patients treated for gastric or duodenal ulcers and preneoplastic lesions. Bismuth and non-bismuth quadruple therapies reached optimal results in almost all indications."

Dyspepsia • Gastric Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Infectious Disease • Oncology • Peptic Ulcer

Indications of Helicobacter pylori Eradication Treatment and Its Influence on Prescriptions and Effectiveness (Hp-EuReg). (PubMed, Helicobacter) - P=N/A | "In Europe, patients with gastric or duodenal ulcers and preneoplastic lesions showed higher H. pylori treatment effectiveness. Bismuth and non-bismuth quadruple therapies achieved optimal results in almost all indications."

Journal • Dyspepsia • Gastric Cancer • Gastroenterology • Gastroesophageal Reflux Disease • Infectious Disease • Oncology • Peptic Ulcer