Eradication of Helicobacter Pylori
Antimicrobial prescribing: NHS Forth Valley
Always test for H. pylori before giving antibiotics.
Treat all positives if known DU, GU, low grade MALToma, or NNT in Non-Ulcer dyspepsia 14.
Do not offer eradication for GORD.
Do not use clarithromycin, metronidazole or quinolone if used in past year for any infection
Penicillin allergy: use PPI + clarithromycin & MTZ. If previous clarithromycin use PPI + bismuth salt + metronidazole + tetracycline.
Relapse and previous MTZ & clari: use PPI + amoxicillin + either tetracycline or levofloxacin. Penicillin allergy: PPI+ tetracycline + levofloxacin.
Retest for H.pylori post DU/GU or relapse after second line therapy: using breath or stool test OR consider endoscopy for culture & susceptibility.
Drug details
Always use PPI.
TWICE DAILY
For 7 days
PPI WITH amoxicillin
1g BD
All for 7 days
MALToma 14 days
PLUS either clarithromycin
500mg BD
All for 7 days
MALToma 14 days
OR metronidazole
400mg BD
All for 7 days
MALToma 14 days
Penicillin allergy & previous clarithromycin PPI WITH bismuth subsalicylate
525mg QDS
All for 7 days
MALToma 14 days
PLUS metronidazole
400mg BD
All for 7 days
MALToma 14 days
PLUS tetracycline hydrochloride
500mg QDS
All for 7 days
MALToma 14 days
Relapse & previous MTZ+clari:
PPI WITH amoxicillin
1 BD
All for 7 days
MALToma 14 days
PLUS tetracycline hydrochloride
500mg QDS
All for 7 days
MALToma 14 days
Bismuth subsalicylate not available on GP10 – if patient unable to purchase – use relapse regime