Following Helicobacter pylori eradication, which combination constitutes first-line triple therapy in areas with clarithromycin resistance <15%, and what is the recommended duration per current ACG/ESGE guidelines?

• A Amoxicillin + clarithromycin + PPI for 7 days (standard triple therapy)
• B Bismuth quadruple therapy for 14 days in all regions regardless of clarithromycin resistance
• C Metronidazole + clarithromycin + PPI for 7 days
• D Amoxicillin + clarithromycin + PPI for 14 days — extended duration improves eradication rates to >90% ✓

Explanation

Current ACG and ESGE guidelines recommend standard clarithromycin-based triple therapy (PPI + amoxicillin + clarithromycin) for 14 days as first-line treatment in regions with clarithromycin resistance <15% and no prior macrolide exposure. Extending from 7 to 14 days significantly improves eradication rates from approximately 70-80% to >90%. In high-resistance areas (>15%), bismuth quadruple therapy or concomitant quadruple therapy is preferred. Metronidazole-based regimens are used when penicillin allergy is present.

Reference: Bailey & Love's Short Practice of Surgery, 27th ed.

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