Eradication of Helicobacter Pylori

Eradication of Helicobacter pylori

NICE dyspepsia

NICE H.pylori

PHE H.pylori

CKS

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.

Always use PPI.

TWICE DAILY

For 7 days

PPI WITH amoxicillin

1g BD

All for 7 days

MALToma 14 days

OR 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