NICE guidelines for H.pylori eradication : >>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>>> ...................................................................... (A) First-line treatment ( triple therapy (1,2):) ............................................................................ 1- ) offer people who test positive for H pylori a 7-day, twice-daily course of treatment with: PPI and amoxicillin 1g and either clarithromycin 500mg or metronidazole 400mg 2- ) offer people who are allergic to penicillin a 7-day, twice-daily course of treatment with: PPI and clarithromycin 250mg and metronidazole 400mg 3- ) offer people who are allergic to penicillin and who have had previous exposure to clarithromycin a 7-day, twice-daily course of treatment with: PPI and bismuth and metronidazole 400mg and tetracycline 500mg B- ) Second-line treatment .......................................................... 1-) offer people who still have symptoms after first-line eradication treatment a 7-day, twice-daily course of treatment with: PPI and amoxicillin 1g bd and either clarithromycin 500mg bd or metronidazole 400mg bd (whichever was not used first-line) 2-) offer people who have had previous exposure to clarithromycin and metronidazole a 7-day, twice-daily course of treatment with: PPI and amoxicillin 1g and a quinolone or tetracycline 500mg 3-) offer people who are allergic to penicillin (and who have not had previous exposure to a quinolone) a 7-day, twice-daily course of treatment with: PPI and metronidazole 400mg and levofloxacin 250mg 4-) offer people who are allergic to penicillin and who have had previous exposure to a quinolone: PPI and bismuth and metronidazole 400mg and tetracycline 500mg ( Seek advice from a gastroenterologist if eradication of H pylori is not successful with second-line treatment ) Notes (2): ....................................................................... A-) there is evidence that the addition of bovine lactoferrin to triple therapy led to an increase in Helicobacter pylori eradication and could be considered helpful for patients with eradication failure & show a positive impact on H. pylori therapy-related side effects.. B- ) quadruple therapy for H. pylori appeared to be more effective than triple therapies for eradicating single-drug resistant H. pylori infection & resistance to metronidazole or clarithromycin could be overcome to a great extent with quadruple therapies given for 5 or more days, especially those containing metronidazole and clarithromycin concomitantly PPI doses for H pylori eradication therapy (Twice daily all ) ................................................................................... Esomeprazole 20mg Lansoprazole 30mg Omeprazole 20-40mg Pantoprazole 40mg Rabeprazole 20mg
Posted on: Wed, 05 Nov 2014 19:56:38 +0000
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