188.8.131.52 H.pylori eradication
|Choice||Drug / Dosage|
|1st choice |
for 7 days
No penicillin allergy:
|Omeprazole 20mg twice daily or lansoprazole 30mg twice daily + amoxicillin 1g twice daily + metronidazole 400mg twice daily|
- 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.