- Check antibiotic history as each additional course of clarithromycin, metronidazole or quinolone increases resistance risk.
- Stress the importance of adherence.
- 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 | Esomeprazole 20mg twice daily |
Penicillin allergy | |
Second-line seven-day triple therapy regimens
ANTIBIOTIC | PROTON PUMP INHIBITOR |
Amoxicillin 1g twice daily | Esomeprazole 20mg twice daily |
Previous clarithromycin and metronidazole exposure | |
or Levofloxacin 250mg twice daily | |
Penicillin allergy + no previous levofloxacin exposure | |
Metronidazole 400mg twice daily and Levofloxacin 250mg twice daily |
Adapted from: PHE. Test and treat for Helicobacter pylori (HP) in dyspepsia. Quick reference guide for primary care: For consultation and local adaptation (July 2017; updated August 2019)
There are additional dosages and regimens licensed for use in H. pylori eradication; refer to individual SPCs for further information.