Drugs for Treatment of Peptic Ulcers

NHSL Medicines Guidance
NHS Lanarkshire

Ulcers Associated With Helicobacter pylori (H. pylori)

Proton pump inhibitor + amoxicillin* + clarithromycin or metronidazole

* Patients who are allergic to penicillin should be given metronidazole 400mg twice daily as an alternative to amoxicillin (N.B. clarithromycin dose should be reduced to 250mg twice daily when used in combination with metronidazole).

Further information can be found at NHSL Adult Primary Care Guidance or BNF Treatment Summary: H. pylori infection.

Failure to eradicate may be due to poor compliance, metronidazole resistance or less commonly clarithromycin resistance.

Stop proton pump inhibitor and antibiotics 2 weeks before H. pylori stool test or endoscopy.

Symptoms may persist for several weeks after treatment. In this event continue proton pump inhibitor therapy for a further 2 to 4 weeks.

If symptoms continue to persist or there is treatment failure, refer for specialist assessment.

NHSL Joint Adult Formulary Key

To indicate the category of a formulary medicine, updated sections adopt the following key:

Preferred list (P): First-line formulary choices.

Total list (T): Alternative choices when preferred list options not effective/not tolerated, or not indicated.

Specialist initiation (S1): Specialist initiation, or on the advice of a Consultant or Specialist Practitioner in this therapeutic area. Continuation in primary care is acceptable.

Specialist use only (S2): Supply via hospital, Homecare Service or a hospital based prescription (HBP) for dispensing by community pharmacy. Not prescribed in primary care setting.

Editorial Information

Last reviewed: 31/01/2022

Next review date: 31/01/2025

Author(s): NHSL.

Version: Please refer to the introduction section for an explanation of the review dates above.

Approved By: ADTC

Reviewer name(s): ADTC.