Which combination constitutes the triple therapy for H. pylori in a penicillin-allergic patient?

• A. Omeprazole, Amoxicillin + Metronidazole
• B. Esomeprazole, Clarithromycin + Metronidazole
• C. Pantoprazole, Clarithromycin + Amoxicillin
• D. Lansoprazole, Clarithromycin + Metronidazole

Answer: (D)

Triple therapy for H. pylori in a penicillin-allergic patient consists of a proton pump inhibitor plus two non-penicillin antibiotics, specifically a macrolide and metronidazole. The idea is to suppress gastric acid to enhance antibiotic efficacy while using antibiotics that don’t rely on penicillin. Lansoprazole shown here serves as the acid-suppressing part, paired with clarithromycin and metronidazole to attack the bacteria without using any β-lactam antibiotic. This combination matches the standard penicillin-free regimen: a PPI plus clarithromycin and metronidazole. Regimens that include amoxicillin aren’t suitable for someone with a penicillin allergy, which is why those options aren’t appropriate. In practice, any PPI can be used, but the key is the penicillin-free trio of a PPI with clarithromycin and metronidazole for this scenario.