Eradication of Helicobacter Pylori

Eradication of Helicobacter pylori

NICE dyspepsia

NICE H.pylori

PHE H.pylori

CKS

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.

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