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1.3 Ulcer-healing drugs

1.3 ULCER-HEALING DRUGS

1.3 Ulcer-Healing Drugs

       Helicobacter pylori eradication regimen (see MicroGuide for further information on eradication therapy)

       First Line 
                     GREEN      Lansoprazole 30mg 12 hourly 
                     GREEN      Clarithromycin 500 mg 12 hourly 
                     GREEN      Amoxicillin 1g 12 hourly

                     Total duration of therapy 7 days 

       Alternative for patients with penicillin allergy 
                     GREEN      Lansoprazole 30mg 12 hourly 
                     GREEN      Metronidazole 400mg 12 hourly 
                     GREEN      Clarithromycin 500mg 12 hourly  
                     Total duration of therapy 7 days
 
       Quadruple Therapy - on specialist advice & in line with NICE guidance
       For patients who are allergic to penicillin and who have had previous exposure to clarithromycin
                     GREEN      Lansoprazole 30mg 12 hourly
                     GREEN      Metronidazole 400mg 12 hourly 
                     GREEN      Bismuth subsalicylate 262.5mg [only for use in quadruple therapy] 2 x 262.5mg four times daily
                     GREEN      Tetracycline 250mg 2 x 250mg four times a  day


       Second Line  
                     GREEN      Lansoprazole 30mg 12 hourly 
                     GREEN      Amoxicillin 1g 12 hourly 
                     GREEN      Clarithromycin 500mg orally BD or Metronidazole 400mg BD (whichever was not used first line) 
                     Total duration of therapy 7 days 

       Patients who have had previous exposure to Clarithromycin and Metronidazole 
                     GREEN      Lansoprazole 30mg 12 hourly 
                     GREEN      Amoxicillin 1g 12 hourly 
                     GREEN      Levofloxacin 250mg 12 hourly
                     Total duration of therapy 7 days
                     RED            Levofloxacin IV
       Second line alternative if allergic to penicillin
                     GREEN      Lansoprazole 30mg 12 hourly
                     GREEN      Metronidazole 400mg BD
                     GREEN      Levofloxacin 250mg 12 hourly 

                     Total duration of therapy 7 days

    1.3.1 H2 receptor antagonists

           All heal gastric and duodenal ulcers by reducing gastric acid output by H2 receptor blockade, and relieve peptic oesophagitis.

                     GREEN      Ranitidine 
                                        tablets 150mg, 300mg , dispersible tablets 150mg    
                                        syrup 75mg/5mL (paediatric use only)
 
                     RED           Ranitidine injection 25mg/mL IV infusion 50mg in 50mL
 
                     AMBER      
                                        Famotidine tablets 20mg  [for use in exceptional circumstances as an alternative  to ranitidine when all other 
                                        treatment options have been explored ie switch to first line omeprazole or lansoprazole if omeprazole
                                        interacts with current medicines prescribed - see Hot Topic
                     GREEN      Nizatidine capsules 150mg, 300mg
                                       [for use in exceptional circumstances as an alternative to ranitidine when all other treatment options have 
                                       been explored ie switch to first line omeprazole or lansoprazole if omeprazole interacts with current 
                                       medicines prescribed]
 


    1.3.3 Chelates and Complexes

                     RED           Sucralfate tablets 1g, 
                     AMBER     Sucralfate suspension 1g/5ml [Sigma pharmaceuticals plc]


    1.3.5 Proton pump inhibitors

                     GREEN      Omeprazole 
                                        capsules 10mg, 20mg    
                     GREEN      Lansoprazole  
                                        capsules 15mg, 30mg    
                                        orodispersible tablets 15mg, 30mg (for tubes, swallowing difficulties)        
                     AMBER     Omeprazole dispersible tablets 10mg  (for use in paediatrics only)
 
                     RED           Omeprazole intravenous infusion 40mg
                     RED           Pantoprazole IV [powder for solution for injection]
                     BLACK     Omeprazole liquid * Not recommended for prescribing in primary or secondary care
                                      Prescribers should use;
                                     * Paediatrics - Omeprazole gastro-resistant dispersible tablets (link to leaflet)
                                     * Adults with swallowing difficulties - Lansoprazole orodispersible tablets

 

       Esomeprazole 
       Esomeprazole should only be initiated by a consultant gastroenterologist in patients with treatment resistant severe
       GORD confirmed by endoscopy, who have failed to respond to the use of high doses of generic omeprazole and/or 
       lansoprazole.
       Esomeprazole should not be initiated by prescribers within primary care, nor should it be used in the treatment of
       dyspepsia or in H.pylori eradication regimes or for any other indication. 
       After 8 weeks therapy with esomeprazole patients should be reviewed and stepped down to a generic PPI where possible. 
  
                       AMBER    Esomeprazole capsules 20mg
 
 
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