Management of Helicobacter pylori

Helicobacter pylori (H. pylori) is a bacterium colonising the gastric mucosa and may be the causative agent in a number of gastrointestinal pathologies.

Assessment / monitoring

Initial testing for H. pylori may be done by carbon-13 urea breath test, stool antigen test, or when performance has been validated, laboratory-based serology.

Drug therapy

One week therapy with a proton pump inhibitor (PPI) and two antibiotics is recommended:

Omeprazole oral 20mg twice daily (or lansoprazole oral 30mg twice daily)

and

Clarithromycin oral 500mg twice daily

and

Amoxicillin oral 1g twice daily OR Metronidazole 400mg twice daily (treatment choice should take into account previous antibiotic exposure)

If penicillin allergy, then prescribe PPI as above as well as: 

Clarithromycin oral 500mg twice daily

and

Metronidazole oral 400mg twice daily.

  • Patients should be counselled on the importance of compliance before starting treatment and in those patients taking metronidazole on the avoidance of alcohol because of the risk of a disulfiram-like reaction.
  • After 1 week's treatment all medication can be stopped, except where ulcers have bled or perforated, when a PPI will be continued.
  • Seek advice from a gastroenterologist if eradication of H. Pylori is not successful

N.B. Healing of gastric ulcers must be confirmed by endoscopy after 6 – 8 weeks.

 

Guideline reviewed October 2023
Page updated October 2023



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