contains treatment regimens for Helicobacter pylori

1. PEPTIC ULCER DISEASE
MANAGEMENT OF H. PYLORI
KDJ

2. Tests for H.pylori
Diabact UBT
Helicobacter Test Hp-Plus®
Helicobacter Test INFAI®
Pylobactell®

3. Precautions
 The test should not be performed within 4 weeks of
treatment with an antibacterial or within 2 weeks of
treatment with an antisecretory drug.
 However, the appropriateness of testing for H.pylori
infection in children has not been established.

4. Drug regimens used
 Anti-acids combined with anti-bacterials eradicate
H. pylori in 90% cases.
 Failure of therapy is either due to poor copmliance or
resistance.
 Reinfection is rare.
 Before therapy, it should first be established that H.
pylori is the cause.
 Antibiotic induced colitis is an uncommon risk.

5. Regimens principle
 Triple therapy: It includes a p.p.i., Amoxil, and either
Clari or Metro for 14 days, or 7 days.
 Two week therapy provides better eradication thn a 7
day though with increased adverse effects risk.
 Regimens consisting a p.p.i. and an antibacterial are
licensed though offer less eradication than the triple
therapy thus not recommended.

6. Cont’d
 Tinidazole or tetra used in combination with
antisecretory drugs and antibacterials also eradicate
H.pylori
 Resistance to clari & metro during treatment is much
more common thn 2 Amoxil.
 Thus a regimen with Amoxil & clari is indicated 4
initial therapy and that with Amoxil and metro 4
failure.

7. Cont’d
 Ranitide bismuth citrate may be substituted for a
p.p.i.
 Regimens consisting metro and Clari are for
specialist settings.
 2 wk regimen of ppi+ tripotassium
dicitratobismusthate + 2 antibacterials may used 4
resistant cases.

8. Cont’d
 There’s no need to continue antisecretory drugs &
H2-receptor antagonists after therapy unless there’s
complication of hemorrhage, and perforation.
 Healing maybe compromised by use of NSAIDS

9. Regimens
 Omeprazole (20mg, bd)+ Amoxil(0.5g, tds) +
Metro(0.4g tds)
 Omeprazole (20mg, bd) +Amoxil(1g, bd) + Clari(.5g
bd)
 Omeprazole (20mg, bd) +Clari(.5g, bd) + Metro(.4
bd)
 Lansoprazole (30mg) + Amoxil(1g, bd) + Clari(.5g
bd)

10. Cont’d
 Lansoprazole (30mg, bd) + Amoxil(1g bd) + (Metro,
.4g, bd)
 Lansoprazole (30mg, bd)+ Clari(.5g, bd)+ Metro(.4g,
bd)
 Ranitidine bismuth citrate (.4g, bd) + {Amoxil (1g,
bd)+ clarithromycin(.5g, bd)} or +{Amoxil, 1g, bd +
Metro, .4g, bd),or + { Clari, .5g, + metro, .4g, bd)}