H Pylori: Eradication Therapy

 First Line Therapy

• Choose the treatment regimen with the lowest acquisition cost and take into account previous exposure to clarithromycin or metronidazole (it is not necessary to consider previous metronidazole exposure in patients with penicillin allergy).

 First-line seven-day triple or quadruple therapy regimens

 Second Line Therapy

• Second-line therapy should use different antibiotics to first-line therapy.
• Seek advice from a gastroenterologist if eradication of H. pylori is not successful with second-line therapy
• Quadruple Therapy includes addition of bismuth to Tetracycline and Metronidazole Combination therapy

Second-line seven-day triple or quadruple therapy regimens

Adapted from:
http://www.mims.co.uk/combination-regimens-eradication-h-pylori-nice-guideline/gi-tract/article/882106