Expansion
Triple therapy: a proton pump inhibitor plus two antibiotics for 7 days
Expansion
First line triple therapy for 7 days
- A proton pump inhibitor twice daily, plus
- Amoxicillin 1 g twice daily, plus
- Clarithromycin 500 mg or metronidazole 400 mg twice daily
In penicillin allergy: a proton pump inhibitor with clarithromycin and metronidazole.
Testing
- Urea breath test or stool antigen are the non-invasive tests, and both are used for confirming eradication
- Serology cannot confirm eradication, since antibodies persist
- Stop the proton pump inhibitor 2 weeks and antibiotics 4 weeks before testing, or the result is falsely negative. This is the commonest practical error
Indications for eradication: peptic ulcer disease, MALT lymphoma, functional dyspepsia, before long term NSAID use in those with an ulcer history, and after gastric cancer resection.
“Test and treat” in uninvestigated dyspepsia under 55 without alarm features; endoscope those with ALARMS: Anaemia, Loss of weight, Anorexia, Recent onset or progressive symptoms, Melaena or haematemesis, Swallowing difficulty.
Confirm eradication in ulcer disease, MALT lymphoma and persistent symptoms, at least 4 to 8 weeks after treatment.