proton pump inhibitor + bismuth subsalicylate + metronidazole + tetracycline

This drug is a fixed combination regimen consisting of a proton pump inhibitor (PPI), bismuth subsalicylate, metronidazole, and tetracycline. It is used as a first-line or salvage therapy for the eradication of Helicobacter pylori infection and associated duodenal ulcers. The mechanism involves multiple actions: - The PPI suppresses gastric acid secretion by inhibiting the H+/K+ ATPase in gastric parietal cells, creating an environment less favorable to H. pylori survival and enhancing antibiotic efficacy. - Bismuth subsalicylate has antimicrobial activity against H. pylori and provides mucosal protection. - Metronidazole acts as a nitroimidazole antibiotic that disrupts DNA synthesis in anaerobic bacteria like H. pylori. - Tetracycline inhibits bacterial protein synthesis by binding to the 30S ribosomal subunit. This combination is recommended in clinical guidelines due to its high efficacy even in areas with significant resistance to other antibiotics such as clarithromycin[1][4]. It is typically administered for 10–14 days.

Brand names

Pylera

Other names

quadruple therapy for H. pyloribismuth quadruple therapy