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 & 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

OR levofloxacin

250mg BD

All for 7 days

MALToma 14 days

Bismuth subsalicylate not available on GP10 – if patient unable to purchase – use relapse regime