| Formulary Chapter 1: Gastro-intestinal system - Full Chapter
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| 01.03 |
Antisecretory drugs and mucosal protectants |
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| 01.03 |
Helicobacter pylori infection |
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Patient education is vital to maximise the likelihood of success. Prescribers and pharmacists should ensure that patients are counselled appropriately. |
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Helicobacter pylori eradication
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Formulary
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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.
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First line (option 1)
First line (option 2)
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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 |
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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* |
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Quadruple therapy
(Penicillin allergy + previous exposure to clarithromycin and/or fluoroquinolone)
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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* |
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| 01.03.01 |
H2-receptor antagonists |
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| 01.03.03 |
Chelates and complexes |
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| 01.03.05 |
Proton pump inhibitors (PPIs) |
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Key |
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Restricted Drug |
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Unlicensed |
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
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Scottish Medicines Consortium |
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Cytotoxic Drug |
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Controlled Drug |
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High Cost Medicine |
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Cancer Drugs Fund |
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NHS England |
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Homecare |
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ICB |
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Low carbon footprint |
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Medium carbon footprint |
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High carbon footprint |
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| Status |
Description |
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Green:
Appropriate for initiation and ongoing prescribing in both primary and secondary care.
Generally, little or no routine drug monitoring is required. |
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Green (Restricted):
Appropriate for initiation and ongoing prescribing in both primary and secondary care provided:
Additional criteria specific to the medicine or device are met, or
The medicine or device is used following the failure of other therapies as defined by the relevant LSCMMG pathway.
Generally, little or no routine drug monitoring is required.
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Red medicines:
Medicine is supplied by the hospital for the duration of the treatment course.
Primary care initiation or continuation of treatment is not recommended unless exceptional circumstances such as specialist GP.
Red medicines are those where primary care prescribing is not recommended. These treatments should be initiated by specialists only and prescribing retained within secondary care. They require specialist knowledge, intensive monitoring, specific dose adjustments or further evaluation in use. If however, a primary care prescriber has particular specialist knowledge or experience of prescribing a particular drug for a particular patient it would not always be appropriate for them to expect to transfer that prescribing responsibility back to secondary care. There should be a specific reason and a specific risk agreement, protocol and service set up to support this.
Primary care prescribers may prescribe RED medicines in exceptional circumstances to patients to ensure continuity of supply while arrangements are made to obtain ongoing supplies from secondary care. |
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Amber level 0:
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Little or no specific monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Brief prescribing document or information sheet may be required.
Primary care prescribers must be familiar with the drug to take on prescribing responsibility or must get the required information.
When recommending or handing over care, specialists should ask primary care prescribers to take over prescribing responsibility, and should give enough information about the indication, dose, monitoring requirements, use outside product licence and any necessary dose adjustments to allow them to confidently prescribe. |
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Amber level 1 (with shared care):
Suitable for prescribing in primary care following recommendation or initiation by a specialist.
Minimal monitoring required.
Patient may need a regular review, but this would not exceed that required for other medicines routinely prescribed in primary care.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Primary care prescribers are advised not to take on prescribing of these medicines unless they have been adequately informed by letter of their responsibilities with regards monitoring, side effects and interactions and are happy to take on the prescribing responsibility. A copy of locally approved shared care guidelines should accompany this letter which outlines these responsibilities. Primary care prescribers should then tell secondary care of their intentions as soon as possible by letter so that arrangements can be made for the transfer of care. |
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Amber level 2 (with shared care and enhanced service):
Initiated by specialist and transferred to primary care following a successful initiation period.
Significant monitoring required on an on-going basis.
Full prior agreement about patient’s on-going care must be reached under the shared care agreement.
Suitable for enhanced service.
These medicines are considered suitable for GP prescribing following specialist initiation of therapy, as per shared care document which will be sent out with the request to prescribe, with on-going communication between the primary care prescriber and specialist. Amber Level 2 medicines require significant monitoring for which an enhanced service may be suitable. (Subject to local commissioning agreements). |
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Do not prescribe: NOT recommended for use by the NHS in Lancashire and South Cumbria.
Includes medicines that NICE has not recommended for use and terminated technology appraisals, unless there is a local need. |
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Grey medicines:
Medicines which have not yet been reviewed or are under the review process.
GPs and specialists are recommended not to prescribe these drugs.
This category includes drugs where funding has not yet been agreed.
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Refer to local guidance and local commissioning arrangements |
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