H. Pylori Eradication

Pathogens

• H. pylori

Drug Treatment

• Duration: 7 days (repeat course for 14 days if initial treatment fails)

First-Line

omeprazole HMLSchedNZFPMLnoids Omeprazole F: 0.5 Half life: 1 hour Elimination: CYP2C19 (80%) fe: 0 Additional points: Inhibits 2C19. Do not crush or chew the modified-release dose form.

PO 20 mg twice a day for 7 days

• Metabolised by and inhibits CYP2C19. (fe = 0).
• Approximate dose equivalents for patients already on a proton pump inhibitor are omeprazole 20 mg = lansoprazole 30 mg = pantoprazole 40 mg twice a day.

AND

amoxicillin HMLSchedNZFPMLnoids Amoxicillin F: 0.9 Half life: 2 hours Elimination: renal fe: 0.9

PO 1000 mg twice a day for 7 days

• fe = 0.9, consider adjusting dose if CrCl is reduced.

AND

clarithromycin HMLSchedNZFPMLnoids Clarithromycin F: 0.5 Half life: 4 hours Elimination: CYP3A fe: 0.2 Additional points: Inhibits CYP3A and Pgp.

PO 500 mg twice a day for 7 days

• Metabolised by and strongly inhibits CYP3A - multiple drug interactions, and inhibits 2C19. (fe = 0.2).

Penicillin allergy

• Metabolised by and inhibits CYP2C19. (fe = 0).
• Approximate dose equivalents for patients already on a proton pump inhibitor are omeprazole 20 mg = lansoprazole 30 mg = pantoprazole 40 mg twice a day.

AND

metronidazole HMLSchedNZFPMLnoids Metronidazole F: 1 Half life: 8 hours Elimination: oxidation, glucuronidation fe: 0.1

PO 400 mg twice a day for 7 days

• Metabolised by unknown pathways. (fe = 0.1).

AND

• Metabolised by and strongly inhibits CYP3A - multiple drug interactions, and inhibits 2C19. (fe = 0.2).

Second-Line

• Consult Gastroenterology. Consider quadruple therapy for 2 weeks with omeprazole 20 mg PO twice a day, colloidal bismuth subcitrate PO 120 mg four times a day, metronidazole PO 400 mg four times a day and tetracycline PO 500 mg four times a day. Community pharmacies may take a few days to access these.

Topic Code: 99231

must be prescribed or recommended by a consultant.