Lancashire and South Cumbria
Formulary
 
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1 Gastro-intestinal system
01-03 Helicobacter pylori infection

Patient education is vital to maximise the likelihood of success. Prescribers and pharmacists should ensure that patients are counselled appropriately.


Helicobacter pylori eradication
Formulary

The following information should be used in conjunction with NICE CG184 

*In January 2024, the MHRA published a Drug Safety Update on fluoroquinolone antibiotics. These must now only be prescribed when other commonly recommended antibiotics are inappropriate. NICE is assessing the impact of this warning on recommendations in this guideline.

All courses are 7 days.

First line (option 1)

 

 

 First line (option 2)

PPI BD (Prescribe most cost-effective PPI)

Clarithromycin 500mg BD

Amoxicillin 1g BD

 Or

PPI BD (Prescribe most cost-effective PPI)

Metronidazole 400mg BD

Amoxicillin 1g BD

Penicillin allergic (1st line)

 

 

 

Penicillin allergic (2nd line)

PPI BD (Prescribe most cost-effective PPI)

Metronidazole 400mg BD

Clarithromycin 500mg BD

 

PPI BD (Prescribe most cost-effective PPI)

Metronidazole 400mg BD

Levofloxacin 250mg BD*

Quadruple therapy

(Penicillin allergy + previous exposure to clarithromycin and/or fluoroquinolone)

PPI BD (Prescribe most cost-effective PPI)

Metronidazole 400mg BD

Bismuth subsalicylate 525mg QDS

Tetracycline 500mg QDS
Previous exposure to clarithromycin and metronidazole

PPI BD (Prescribe most cost-effective PPI)

Amoxicillin 1g BD

Tetracycline 500mg QDS OR

Levofloxacin 250mg BD*

 

Link  MHRA: Fluoroquinolone antibiotics: must now only be prescribed when other commonly recommended antibiotics are inappropriate
Link  MHRA: Fluoroquinolone antibiotics: new restrictions and precautions for use due to very rare reports of disabling and potentially long-lasting or irreversible side effects
Link  NICE NG184: Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management

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