Helicobacter Pylori Infection
Suspected Helicobacter pylori infection should not be treated empirically. Always wait for confirmation of H. pylori infection before commencing treatment.
e-prescribing: Use the 'H pylori Eradication' powerplan on EPR.
For patients with penicillin allergy label consider penicillin allergy assessment and delabelling
First line - 7 days treatment
Omeprazole 40mg po bd AND amoxicillin 1g po bd AND clarithromycin 500mg po bd
For penicillin allergy (non-severe and severe)
Omeprazole 40mg po bd AND clarithromycin 500mg po bd AND metronidazole 400mg po bd
Conduct Stool Antigen Test (SAT), earliest 4 weeks after completion of antibiotics and 2 weeks after finishing course of PPI
Second line - 14 days treatment
Omeprazole 40mg po bd AND amoxicillin 1g po bd AND metronidazole 400mg po bd
For penicillin allergy (non-severe and severe):
Omeprazole 40mg po bd AND metronidazole 400mg po bd AND levofloxacin* 250mg po bd
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including levofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.
Conduct Stool Antigen Test (SAT), earliest 4 weeks after completion of antibiotics and 2 weeks after finishing course of PPI
In case of second line failure refer to gastroenterology for OGD and culture. This will guide sensitivity directed therapy.
If OGD result available:
Sensitivity directed treatment.
If OGD is not possible:
Empiric treatment is required. See below.
Empiric Third Line
Omeprazole 40mg po bd AND amoxicillin 1g po bd AND levofloxaxcin* 250mg po bd for 14 days
*Ensure that the patient is given the Fluoroquinolone MHRA patient information leaflet. Fluoroquinolones, including levofloxacin are associated with disabling and potentially long-lasting or irreversible side effects. See Fluoroquinolone antibiotics - severe adverse effects.
For penicillin allergy (non-severe and severe):
Pylera® 3 capsules po qds AND Omeprazole 20mg po bd for 10 days
Pylera® is Bismuth potassium with metronidazole and tetracycline hydrochloride 140/125/125 mg capsules
Empiric Fourth line
Pylera® 3 capsules po qds AND Omeprazole 20mg po bd for 10 days
Pylera® is Bismuth potassium with metronidazole and tetracycline hydrochloride 140/125/125 mg capsules
For penicillin allergy (non-severe and severe):
- Individualised regimen considering previously prescribed medications.
- Re-visit options for culture.
- Re-visit consideration of penicillin allergy assessment and delabelling in patients who are low risk and are clinically stable.
Rescue Options
Esomeprazole 40mg po bd AND amoxicillin 1g po qds AND rifabutin 150mg po bd for 10 days
For penicillin allergy (non-severe and severe):
- Individualised regimen considering previously prescribed medications.
- Re-visit options for culture.
- Re-visit consideration of penicillin allergy assessment and delabelling in patients who are low risk and are clinically stable.