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Endoscopy Unit Documentation 2011 NHS Lothian Lothian Health Guidelines on Eradication of
HELICOBACTER PYLORI
The Helicobacter Pylori eradication regimes used in the Royal Infirmary of Edinburgh are those recommended by the multidisciplinary group from the Lothian University NHS Trust (Royal Infirmary and Western General Hospital) and St John's Hospital, West Lothian (2003).  Acid lowering drug therapy enhances the efficacy of H.pylori eradication therapy and can usually be discontinued after ONE WEEK unless there is a complicating factor such as gastric ulcer, perforated ulcer, bleeding ulcer, NSAID therapy or troublesome reflux symptoms  The combination of TWO antibiotics together with a Formulary PPI given for at least ONE WEEK is required to ensure H.pylori eradication rates >85%  ‘Blind' anti- H.pylori therapy without prior confirmation of H.pylori status is only appropriate in Helicobacter pylori eradication therapy
First line therapy:
Second line therapy:
First line if penicillin
allergic:
Second line if penicillin
allergic:
 Up to 30% of patients will experience diarrhoea with H.pylori eradication therapy. Patients should be warned of this adverse effect and advised to complete the therapy. Serious side effects are rare  Patients should avoid alcohol during metronidazole therapy because of the possibility of  Contraceptive drug therapy is less effective during antibiotic therapy and the use of an additional barrier contraceptive method is strongly advised  A paediatrician should supervise H.pylori eradication in children  Symptoms may persist beyond 1 week where there has been peptic ulceration. In this event, the PPI should be continued alone for up to four weeks (especially if gastric ulcer)  The absence of symptoms 4 weeks after eradication therapy is strong evidence that eradication has been successful. Confirmation of H.pylori eradication in patients who are asymptomatic at 4 weeks is unnecessary unless there has been bleeding or perforation of a peptic ulcer or where there are relevant ongoing risk factors e.g. anti-coagulant or NSAID therapy. When indicated, the H.pylori breath test is best deferred for 5 weeks after the conclusion of eradication therapy.  H.pylori eradication therapy interacts with warfarin and may cause disturbances in INR Please Note: The information contained within this document is under Copyright and has been prepared by the Endoscopy Unit for the sole purpose of
informing Clinical Staff of the protocols and Guidelines adopted within this unit and should not be freely distributed.
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Source: http://www.mph.ed.ac.uk/endo/docs/clininfo/Lothian%20Health%20Guidelines%20on%20Eradication%20of%20HELICOBACTER%20PYLORI.pdf