bismuth + pantoprazole + tetracycline + tinidazole

This is a quadruple therapy regimen used for the eradication of Helicobacter pylori infection, particularly as a rescue treatment after failure of standard triple therapy. The combination works through multiple mechanisms to eliminate H. pylori bacteria from the stomach and duodenum. Pantoprazole reduces stomach acid production, creating a less acidic environment. Bismuth disrupts bacterial cell membranes and increases the effects of antibiotics. Tetracycline inhibits bacterial protein synthesis. Tinidazole (similar to metronidazole) damages bacterial DNA. This combination therapy is typically administered for 7-10 days.