proton pump inhibitor + amoxicillin + metronidazole

A combination therapy consisting of a **proton pump inhibitor (PPI)**, **amoxicillin**, and **metronidazole** is used as a triple therapy primarily for the eradication of *Helicobacter pylori* infection in the stomach. The PPI reduces gastric acid secretion, thereby enhancing the effectiveness of the antibiotics and providing ulcer healing. **Amoxicillin** is a beta-lactam antibiotic that inhibits bacterial cell wall synthesis, while **metronidazole** is a nitroimidazole antibiotic effective against anaerobic bacteria, including *H. pylori*. This regimen is often used as an alternative to clarithromycin-containing regimens, especially in areas with high clarithromycin resistance. Efficacy depends on duration and dosing, with 14-day regimens and higher metronidazole doses associated with higher cure rates. The combination is globally recommended in guidelines as a first-line or alternative therapy for *H. pylori* eradication[2][5][6].