What Is Pylera? Uses, Dosage, and What You Need to Know in 2026

If your doctor has told you that you have an H. pylori infection and has prescribed Pylera, you may be wondering: what exactly is this medication, why does it come in a confusing multi-dose pack, and how do you take it correctly? This guide answers all of those questions in plain language.

What Is Pylera?

Pylera is a prescription oral capsule that combines three different medications in a single capsule:

Bismuth subcitrate potassium (140 mg): a mineral compound that disrupts H. pylori bacteria and protects the stomach lining

Metronidazole (125 mg): an antibiotic that kills H. pylori by damaging its DNA

Tetracycline hydrochloride (125 mg): an antibiotic that stops H. pylori from producing the proteins it needs to survive and multiply

Pylera is always used together with a fourth medication called a proton pump inhibitor (PPI), most commonly omeprazole (Prilosec). The PPI reduces acid in your stomach, which creates better conditions for the antibiotics to work.

What Is Pylera Used For?

Pylera is FDA-approved for one indication:

Eradication of Helicobacter pylori (H. pylori) infection in adults with active duodenal ulcer disease or a history of duodenal ulcer within the past 5 years

H. pylori is a bacteria that infects the stomach lining, causing inflammation, gastritis, and — in many cases — painful duodenal ulcers (sores in the upper part of the small intestine). Eliminating H. pylori dramatically reduces the risk of ulcer recurrence and, over time, lowers the risk of gastric cancer.

Pylera is part of what doctors call "bismuth-based quadruple therapy" (BQT) — the four-drug approach (bismuth + metronidazole + tetracycline + PPI) that the 2024 American College of Gastroenterology (ACG) now recommends as the preferred first-line empiric treatment for H. pylori in the United States.

What Is the Correct Pylera Dosage?

The standard Pylera regimen:

Pylera: 3 capsules, taken 4 times daily (after breakfast, after lunch, after dinner, and at bedtime)

Omeprazole: 20 mg, taken twice daily (after morning meal and after evening meal)

Duration: 10 days

Total capsules: 120 Pylera capsules per course (3 capsules × 4 times daily × 10 days)

Each dose delivers a total of: bismuth subcitrate potassium 420 mg, metronidazole 375 mg, and tetracycline 375 mg.

How to Take Pylera Correctly

Swallow capsules whole with a full 8-ounce glass of water — this is especially important for the bedtime dose to prevent esophageal irritation from tetracycline

Always take after eating — taking with food reduces nausea and improves tolerability

Avoid dairy and antacids within 1-2 hours of any Pylera dose — calcium, aluminum, and magnesium bind to tetracycline and reduce its absorption

No alcohol during treatment and for at least 3 days after your last dose

Complete the full 10-day course — stopping early can lead to treatment failure and antibiotic resistance

Who Should Not Take Pylera?

Pylera should not be used if you:

Are pregnant — tetracycline can cause permanent tooth discoloration and bone development issues in the fetus

Are breastfeeding — metronidazole and tetracycline are both present in breast milk

Are under 18 — not approved for pediatric use; tetracycline affects tooth and bone development in children under 8

Have severe kidney or liver disease

Are allergic to bismuth, metronidazole (or other nitroimidazoles), or any tetracycline antibiotic

Have taken disulfiram (Antabuse) within the past 2 weeks

How Effective Is Pylera?

When taken correctly as part of bismuth quadruple therapy, eradication rates of 90–97% have been reported in clinical studies, depending on treatment duration (10 vs. 14 days). This makes bismuth quadruple therapy one of the highest-efficacy H. pylori regimens available, particularly in areas with high clarithromycin resistance.

For help finding Pylera at a pharmacy near you, visit medfinder — we contact pharmacies on your behalf to find where it's in stock.