Eradication of Helicobacter Pylori
NHSL Antimicrobial Guidelines
Eradication of Helicobacter Pylori
CKS: Dyspepsia - unidentified cause
NICE BNF: Helicobacter pylori infection
PHE Guidance: Helicobacter pylori in dyspepsia: test and treat
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 & metronidazole.
If previous clarithromycin use PPI (omeprazole) + Pylera for 10 days.
Relapse and previous metronidazole & clarithromycin: 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
Drug
Always use PPI.
Dosage
Twice daily
Duration
All:
for 7 days
MALToma 14 days
Drug
PPI with Amoxicillin
Dosage
1g BD
Drug
Plus either:
Clarithromycin
Dosage
500mg BD
Drug
Or
Metronidazole
Dosage
400mg BD
Drug
Penicillin allergy & previous Clarithromycin
PPI with De-noltab® (TripotassiumDicitratobismuthate)
Dosage
240mg BD
Dosage
3 capsules four times daily (with omeprazole 20 mg capsule/tablet twice a day) for 10 days.
| Time of dose | Number of capsules of Pylera | Number of capsules/tablets of omeprazole |
| After breakfast | 3 | 1 |
| After lunch | 3 | 0 |
| After evening meal | 3 | 1 |
| At bedtime (preferably after a snack) | 3 | 0 |
Drug
Relapse & previous MTZ+Clari:
PPI with Amoxicillin
Dosage
1g BD
Drug
Plus
Tetracycline Hydrochloride
Dosage
500mg QDS
Drug
Or
Levofloxacin
Dosage
250mg BD