Always use PPI.
TWICE DAILY
All:
for 7 days
MALToma 14 days
PPI WITH amoxicillin
1g BD
or either clarithromycin
500mg BD
OR metronidazole
400mg BD
Penicillin allergy & previous clarithromycin PPI WITH De-nol tab® (tripotassium dicitratobismuthate)
240mg BD
OR bismuth subsalicylate +
525mg QDS
metronidazole +
400mg BD
tetracycline hydrochloride
500mg QDS
Relapse & previous MTZ+clari:
PPI WITH amoxicillin +
1g BD
tetracycline hydrochloride
500mg QDS
OR levofloxacin
250mg BD
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.