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 Formulary Chapter 1: Gastro-intestinal system - Full Chapter
01.03  Expand sub section  Antisecretory drugs and mucosal protectants
01.03  Expand sub section  Helicobacter pylori infection
 note 

PRESCRIBING POINTS FOR HELICOBACTER PYLORI AND PEPTIC ULCER

  • It is recommended that H. pylori is confirmed before starting treatment
  • Patients should be aware that compliance is essential for an effective outcome. They should be warned of potential side-effects. Symptoms do not settle immediately even after successful therapy
  • Confirmation of eradication with a carbon isotope urea breath test requires stopping treatment with PPIs two weeks prior to testing. H2-receptor antagonists are used sometimes to reduce the painful gastric symptoms experienced by patients who must stop PPIs prior to the urea breath test
  • In cases of complicated peptic ulcer, i.e. patients with haemorrhage or perforation - maintenance therapy should only be discontinued once eradication of H. pylori has been confirmed by a carbon isotope urea breath test six weeks after therapy

Table 1: Recommended regimens for Helicobacter pylori eradication for 1 week 
(Note: regimens are based on GI consultant recommendations (based on microbiological resistance and patient compliance) and may differ from BNF recommendations).

TREATMENT (ADULTS) to continue for 7 days

First-line:

Omeprazole 
20mg twice daily
Clarithromycin 
500mg twice daily

Amoxicillin 
1g twice daily

---------

Penicillin allergy 
First-line:

Omeprazole 
20mg twice daily

Clarithromycin 
500mg twice daily

Metronidazole 
400mg twice daily

---------

Second-line:

Omeprazole 
20mg three times daily

Bismuth subsalicylate 
525mg three times daily

Metronidazole 
400mg three times daily

Tetracycline 
500mg three times daily

Third-line/refractory cases - contact Dr Phull

Due to resistance issues if a patient has been treated with clarithromycin in the previous 12 months for any indication consider using a non-clarithromycin based regimen. See NICE guidance (https://www.nice.org.uk/guidance/cg184) or seek local advice for alternatives.

01.03.01  Expand sub section  H2-receptor antagonists
01.03.03  Expand sub section  Chelates and complexes
01.03.05  Expand sub section  Proton pump inhibitors (PPIs) to top
 ....
Key
note Notes
Section Title Section Title (top level)
Section Title Section Title (sub level)
First Choice Item First Choice item
Non Formulary Item Non Formulary section
Restricted Drug
Restricted Drug
Unlicensed Drug
Unlicensed
Track Changes
Display tracking information
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Link to adult BNF
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Link to children's BNF
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Link to SPCs
SMC
Scottish Medicines Consortium
Cytotoxic Drug
Cytotoxic Drug
CD
Controlled Drug
High Cost Medicine
High Cost Medicine
Homecare
Homecare

Traffic Light Status Information

Status Description

Green

General use.
Treatment may be initiated in either Primary or Secondary Care.  

Amber 1

Available for restricted use under specialist supervision.
Treatment may be initiated in Primary Care on the recommendation of a consultant/specialist.  

Amber 2

Available for restricted use under specialist supervision.
Treatment to be initiated in hospital prior to handover.  

Red

Hospital use only.
Treatment should be supplied by the hospital for the duration of the treatment course.  

Blue

Products shown as blue have multiple indications with varying formulary classifications. For further information see text next to the product.  

Grey

Work is ongoing and will be reviewed at a future meeting  

Non Formulary

Not routinely available in NHS Grampian however if local need is identified:
  • Contact the Pharmacist Team Leader/Principal Pharmacist Supply (ARI)
  • Treatment is available:
    • From a Specialist Centre in another health board
    • From the National Specialist Service for pulmonary arterial hypertension (Scottish Pulmonary Vascular Unit or similar specialists)
    • Through the National Services Scotland:
      • Ultra-Orphan Medicines Risk Share Scheme
      • Inherited Metabolic Disorders Risk Share Scheme
    • For SMC recommended medicines/indications where local clinical experts do not wish to add to the formulary at this time
  

Black

Not routinely available in NHS Grampian.
Includes medicines/indications that:
  • Are not recommended for use within NHS Grampian
  • Are not recommended for use within NHS Scotland
  • Have not been considered by SMC or NHSG Formulary Group
  • Are not recommended for use at present due to limited clinical and/or cost effective data
  • There is a local preference for alternative medicines
  

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