rabeprazole + tripotassium dicitrate bismuthate + metronidazole + tetracycline

This is a fixed-dose combination therapy consisting of four active pharmaceutical ingredients: - **Rabeprazole** (a proton pump inhibitor), - **Tripotassium dicitrate bismuthate** (a bismuth salt with gastroprotective and antibacterial properties), - **Metronidazole** (a nitroimidazole antibiotic effective against anaerobic bacteria and protozoa), - **Tetracycline** (a broad-spectrum tetracycline-class antibiotic). The combination is used as a quadruple therapy for the eradication of *Helicobacter pylori* infection, particularly in cases where resistance to clarithromycin or other first-line regimens is suspected or confirmed. Rabeprazole suppresses gastric acid secretion by inhibiting the H+/K+-ATPase enzyme in gastric parietal cells, creating an environment less favorable for *H. pylori* survival and enhancing antibiotic efficacy. Tripotassium dicitrate bismuthate exerts direct bactericidal effects on *H. pylori*, disrupts bacterial cell walls, inhibits bacterial enzymes, and provides mucosal protection. Metronidazole targets anaerobic bacteria by disrupting DNA synthesis, while tetracycline inhibits protein synthesis by binding to the 30S ribosomal subunit of susceptible organisms. This regimen is recommended as a first-line or rescue treatment for *H. pylori* eradication in regions with high rates of clarithromycin resistance[1][2]. The combination has demonstrated high efficacy and acceptable safety profiles in clinical studies.

Other names

Bismuth quadruple therapyRBTM regimenRabeprazole-based bismuth quadruple therapy