Helicobacter pylori eradication regimen (see MicroGuide for further information on eradication therapy)
First Line
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GREEN Lansoprazole 30mg 12 hourly
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GREEN Clarithromycin 500 mg 12 hourly
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| GREEN Amoxicillin 1g 12 hourly |
Total duration of therapy 7 days
Alternative for patients with penicillin allergy
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GREEN Lansoprazole 30mg 12 hourly
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GREEN Metronidazole 400mg 12 hourly
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GREEN Clarithromycin 500mg 12 hourly
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| Total duration of therapy 7 days |
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| 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
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GREEN Lansoprazole 30mg 12 hourly
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GREEN Amoxicillin 1g 12 hourly
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GREEN Clarithromycin 500mg orally BD or Metronidazole 400mg BD (whichever was not used first line)
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Total duration of therapy 7 days
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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
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| 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
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| tablets 150mg, 300mg , dispersible tablets 150mg |
| syrup 75mg/5mL (paediatric use only) |
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| RED Ranitidine injection 25mg/mL IV infusion 50mg in 50mL |
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GREEN Famotidine tablets 20mg [for use in exceptional circumstances as an alternative to ranitidine when all other
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| treatment options have been explored ie switch to first line omeprazole or lansoprazole if omeprazole |
| interacts with current medicines prescribed. |
| 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,
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| AMBER Sucralfate suspension 1g/5ml [Sigma pharmaceuticals plc] |
1.3.5 Proton pump inhibitors
GREEN Omeprazole
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| capsules 10mg, 20mg |
GREEN Lansoprazole
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| capsules 15mg, 30mg |
| *orodispersible tablets 15mg, 30mg |
| *(for tubes, swallowing difficulties and 1st line PPI in children 1 month - 17 years weighing 2.5kg and above) |
| AMBER Omeprazole dispersible tablets 10mg (for use in neonates and children weighing less than 2.5kg) |
| See leaflet information: Proton Pump Inhibitor use in paediatric patients |
| Pantoprazole and rabeprazole are second line option if intolerance to lansoprazole or omeprazole |
| GREEN Pantoprazole tablets 20mg, 40mg - prescribe generically |
| GREEN Rabeprazole sodium tablets 10mg, 20mg - prescribe generically |
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 - Lansoprazole orodispersible tablets (link to information leaflet) | | * Adults with swallowing difficulties - Lansoprazole orodispersible tablets |
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Esomeprazole Esomeprazole gastro-resistant granules can be prescribed for children 1 month – 17 years with an enteral feeding tube of size 6-8Fr, or as an alternative to lansoprazole orodispersable tablets if the enteral feeding tube becomes blocked.
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GREEN Esomeprazole gastro-resistant granules 10mg, Esomeprazole 20mg capsules.
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