Eradication of Helicobacter Pylori

PHS H pylori quick reference guide for primary care

N.B. as of Jan 2025 H pylori culture & sensitivities (on gastric biopsy) is not available as service has been paused at Gastrointestinal Bacterial Reference Unit, UKHSA.

NHS FV uses the Stool Antigen Test (SAT) to investigate for H pylori carriage.

Always test for H. pylori before considering eradication regimen

SAT should not be performed within:

- 2 weeks of finishing PPI

- 4 weeks of finishing antibiotic(s)

- min. 4 weeks (ideally 8 weeks) of finishing H pylori eradication regimen i.e. PPI and antibiotics.

as risk of false negative results.

Drug details

First Line:

PPI

AND

Amoxicillin

AND

Metronidazole

BD (e.g. Omeprazole 20mg BD)

1g BD

400mg BD

PPI and Antibiotics must be taken together for 7 days

Second Line:

PPI

AND

Amoxicillin

AND

Clarithromycin

BD (e.g. Omeprazole 20mg BD)

1g BD

500mg BD

PPI and Antibiotics must be taken together for 7 days

First Line (Penicillin Allergy):

PPI

AND

Clarithromycin

AND

Metronidazole

BD (e.g Omeprazole 20mg BD)

500mg BD

400mg BD

PPI and Antibiotics must be taken together for 7 days

Second Line (Penicillin Allergy)

Third Line (non-penicillin allergy):

PPI WITH Pylera

Omeprazole 20mg BD

Pylera 3 capsules QDS

Duration: 10 days

Time of dose	No. of capsules of Pylera	No. of capsules of omeprazole
After breakfast	3	1
After lunch	3	0
After evening meal	3	1
At bedtime (preferably after snack)	3	0