Eradication of Helicobacter Pylori

Warning

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 + bismuth salt + metronidazole + tetracycline.

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

Drug

Or
Bismuth Subsalicylate +

Dosage

525mg QDS

Drug

Plus Metronidazole

Dosage

400mg BD

Drug

And
Tetracycline Hydrochloride

Dosage

500mg QDS

Drug

Relapse & previous MTZ+Clari:
PPI with Amoxicillin

Dosage

1g BD

Drug

Plus
Tetracycline Hydrochloride

Dosage

500mg QDS

Drug

Or
Levofloxacin

Dosage

250mg BD

Editorial Information

Last reviewed: 22/03/2021

Next review date: 22/03/2024

Author(s): NHS Lanarkshire Antimicrobial Management Committee, Dr Dundas, Dr Hylands, S McCormick.

Approved By: AMC; ADTC

Reviewer name(s): NHS Lanarkshire Antimicrobial Management Committee.