Helicobacter pylori (H pylori) infection is one of the most common chronic bacterial infection. H pylori infection is associated with peptic ulcer disease and gastric cancer. In the US, most commonly used therapies for H pylori eradication include clarithromycin-based triple therapy (PPI, clarithromycin, and amoxicillin) and quadruple therapy (PPI, bismuth, metronidazole, and tetracycline). According to the 2017 ACG Clinical Guidelines for treatment of H pylori infection, quadruple therapy is preferred in patients with any previous macrolide exposure or high local clarithromycin resistance (>15% failure rate).