Helicobacter pylori Infection in adults |
Publication: 01/01/2008 -- |
Last review: 26/10/2021 |
Next review: 09/08/2024 |
Clinical Guideline |
CURRENT |
ID: 1210 |
Approved By: Improving Antimicrobial Prescribing Group |
Copyright© Leeds Teaching Hospitals NHS Trust 2021 |
This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated. |
GUIDELINE FOR TREATMENT OF HELICOBACTER PYLORI INFECTION IN ADULTS
DIAGNOSTICS
Who should be tested for H. pylori |
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Investigations required (one of the following) |
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Non-antimicrobial management |
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Patients who should be re-tested |
Stool sample (faecal antigen test): this should be at least 4 weeks after eradication for PUD, gastric cancer of MALToma. |
EMPIRICAL TREATMENT
- Offer treatment to all patients newly diagnosed with H. pylori .
- Do not use clarithromycin or metronidazole if patient has a history of use in the past year for any infection.
- Do not retest or retreat for uninvestigated dyspepsia or functional dyspepsia
Empirical options for H pylori eradication |
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Durations |
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First line options - all options to be given orally (PO) |
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1st line |
Penicillin allergy |
Penicillin allergy and previous exposure to clarithromycin1 |
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Lansoprazole |
Lansoprazole |
Lansoprazole |
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Second line options - all options to be given orally (PO)
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2nd line |
Previous exposure to clarithromycin and metronidazole |
Penicillin allergy |
Penicillin allergy and previous exposure to a quinolone1 |
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Lansoprazole |
Lansoprazole |
Lansoprazole |
Lansoprazole |
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Third line options |
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Seek advice from Gastroenterology if failure of eradication with second line regimens (peptic ulcer disease or MALToma only). |
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Provenance
Record: | 1210 |
Objective: | |
Clinical condition: | Helicobacter Pylori Infection |
Target patient group: | Adults |
Target professional group(s): | Secondary Care Doctors Pharmacists Primary Care Doctors Primary Care Nurses Secondary Care Nurses |
Adapted from: |
Evidence base
Adapted from: NICE. Clinical Guideline [CG184) Gastro-oesophageal reflux disease and dyspepsis in adults: investigation and management. NICE 2014, London. https://www.nice.org.uk/guidance/cg184/chapter/1-recommendations?unlid=6240325232015794309#helicobacter-pylori-testing-and-eradication
- North of England Dyspepsia Guideline Development Group (2004). Dyspepsia – managing dyspepsia in adults in primary care. Centre for Health Services Research report no 112 [online].Newcastle, University of Newcastle. Available from the World Wide Web: [Accessed 4th Aug 2006]
- Delaney BC, Qume M, Moayyedi P, Logan RFA, Ford AC, Elliott C, McNulty C, Wilson S, Hobbs FDR. Helicobacter pylori test and treat versus proton pump inhibitor in initial management of dyspepsia in primary care: multicentre randomised controlled trila (MRC-CUBE trial). British Medical Journal 2008; 336: 651-654.
- Fischbach L and Evans EL. Meta-analysis: the effect of antibiotic resistance status on the efficacy of triple and quadruple first-line therapies for Helicobacter pylori. Alimentary Pharmacology & Therapeutics. 2007; 26: 343-357.
- Malfertheiner P, Megraud F, O’Morain C, Bazzoli F, El-Omar E, Graham D, Hunt R, Rokkas T, Vakil N, Kuiper EJ, The European Helicobacter Study Group (EHSG). Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report. Gut 2007; 56: 772-781.
- Costelloe C, Metcalfe C, Lovering A, Mant D, Hay AD. Effect of antibiotic prescribing in primary care on antimicrobial resistance in individual patients: systematic review and meta-analysis. BMJ 2010;340:c2096
- Chey W et al. American College of Gastroenterology Guideline on the Management of Helicobacter pylori Infection. Am J Gastroenterol 2007;102:1808–1825
Approved By
Improving Antimicrobial Prescribing Group
Document history
LHP version 2.0
Related information
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