Prescribing Notes
- Eradication of H. pylori reduces recurrence of gastric and duodenal ulcers and the risk of re-bleeding. The presence of H. pylori should be confirmed before starting eradication treatment
- Refer to Public Health England guidance: Test and treat for Helicobacter pylori in dyspepsia
- Stop PPIs 2 weeks before and antibiotics and bismuth 4 weeks before H. pylori stool antigen test (or breath test)*
- Eradication rates with one-week regimens that include a PPI and amoxicillin with either metronidazole or clarithromycin have fallen to less than 80% due to increased resistance. Treatment failure may reflect poor compliance or resistance to metronidazole or clarithromycin
- Seek advice from a gastroenterologist if eradication of H. pylori is not successful with second line treatment
- Symptoms may persist for some weeks. In this event, continue PPI therapy for up to 4 weeks
* Note: stool antigen test is the test of choice regionally – for further information see here