1.3.5.1 H.pylori eradication

ChoiceDrug / Dosage
1st choice
for 7 days

No penicillin allergy:
Omeprazole 20mg twice daily or lansoprazole 30mg twice daily + amoxicillin 1g twice daily + clarithromycin 500mg twice daily

Or
Omeprazole 20mg twice daily or lansoprazole 30mg twice daily + amoxicillin 1g twice daily + metronidazole 400mg twice daily

Penicillin allergy:
Omeprazole 20mg twice daily or lansoprazole 30mg twice daily +metronidazole 400mg twice daily+ clarithromycin 250mg twice daily

2nd choice

Refer to Public Health England guidance: Test and treat for Helicobacter pylori in dyspepsia

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