Treatment Regimens for Eradication of H. pylori (PHE Guideline)

Summary of PHE guidance on Helicobacter treatment.

  • Check antibiotic history as each additional course of clarithromycin, metronidazole or quinolone increases resistance risk.
  • Stress the importance of compliance.
  • If diarrhoea develops, consider C. difficile and review need for treatment.
  • Seek advice from a gastroenterologist if eradication of H. pylori is not successful with second-line therapy.

 First-line seven-day triple therapy regimens

ANTIBIOTIC

PROTON PUMP INHIBITOR

Amoxicillin 1g twice daily
and either:
Clarithromycin 500mg twice daily
or
Metronidazole 400mg twice daily

Esomeprazole 20mg twice daily
or
Lansoprazole 30mg twice daily
or
Omeprazole 20–40mg twice daily
or
Pantoprazole 40mg twice daily
or
Rabeprazole 20mg twice daily

Penicillin allergy
Metronidazole 400mg twice daily
and
Clarithromycin 500mg twice daily

Second-line seven-day triple therapy regimens

ANTIBIOTIC

PROTON PUMP INHIBITOR

Amoxicillin 1g twice daily
and either:
Clarithromycin 500mg twice daily
or
Metronidazole 400mg twice daily
(whichever was not used first-line)

Esomeprazole 20mg twice daily
or
Lansoprazole 30mg twice daily
or
Omeprazole 20–40mg twice daily
or
Pantoprazole 40mg twice daily
or
Rabeprazole 20mg twice daily

Previous clarithromycin and metronidazole exposure
Amoxicillin 1g twice daily
and either:
Tetracycline 500mg four times daily
or
Levofloxacin 250mg twice daily
Penicillin allergy + no previous levofloxacin exposure
Metronidazole 400mg twice daily
and
Levofloxacin 250mg twice daily

Adapted from:

There are additional dosages and regimens licensed for use in H. pylori eradication; refer to individual SPCs for further information.


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