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).