Testing
- In Primary Care, we only use the Stool Antigen Test (SAT).
- PPIs should be withdrawn for 2 weeks before performing the test.
- This can be ordered through TQuest: (See TQuest)
- Lewisham: Faeces Helicobacter Antigen
- Southwark & Lambeth: H.Pylori Antigen
- Provide the patient with a blue top sample pot to return their stool sample (See Samples)
- Patients may receive other tests if seen in secondary care, including OGD (Gastroscopy) & the Urea Breath Test
Re-testing
Re-testing after eradication should use a Urea Breath Test - There is little evidence for re-testing using a SAT.
- Retesting should be performed at least 4 weeks (ideally 8 weeks) after treatment
- It is not recommended in patients with functional dyspepsia
- Urea Breath Test needs a referral to gastroenterology
Treatment
- We should discuss treatment adherence with the patient, and emphasis the importance of this.
- PHE advises that patients should be referred for an endoscopy, culture and susceptibility testing if the choice of antibacterial treatment is reduced due to: Hypersensitivity, there are known high local resistance rates or patients have previously received treatment with clarithromycin, metronidazole, and a quinolone.
1️⃣ First-line treatment
Most patients:
A 7-day, twice-daily course of:
- a PPI and
- Amoxicillin and
- Clarithromycin or Metronidazole
⚠️ Consider previous exposure to clarithromycin and metronidazole
Patients with penicillin allergy:
A 7-day, twice-daily course of:
- a PPI and
- Clarithromycin and
- Metronidazole
Patients with penicillin allergy & previous exposure to clarithromycin:
A 7-day, twice-daily course of:
- a PPI and
- bismuth [unlicensed use] and
- metronidazole and
- tetracycline [unlicensed use]
⚠️ Seek specialist advice before prescribing
2️⃣ Second-line treatment
Used if symptoms are ongoing after first line treatment.
Most patients:
A 7-day, twice-daily course of:
- a PPI and
- amoxicillin and
- either clarithromycin or metronidazole (whichever was not used first-line, and no previous exposure)
If patient had previous exposure to clarithromycin and metronidazole:
a 7‑day course of:
- a PPI and
- amoxicillin and
- tetracycline [unlicensed use] (or, if a tetracycline cannot be used, levofloxacin [unlicensed use])
⚠️ Seek specialist advice before prescribing
Patients with penicillin allergy:
A 7-day, twice-daily course of:
- a PPI and
- metronidazole and
- levofloxacin [unlicensed use]
⚠️ Seek specialist advice before prescribing
Patients with penicillin allergy & previous exposure to a fluoroquinolone antibiotic:
a 7‑day course of:
- a PPI and
- bismuth [unlicensed use] and
- metronidazole and
- tetracycline [unlicensed use]
⚠️ Seek specialist advice before prescribing
Choosing a PPI
Proton pump inhibitor | Dose | Notes |
Omeprazole | 20–40 mg | First-line (EXCEPT Clopidogrel Patients) |
Lansoprazole | 30 mg | First-line for Clopidogrel patients |
Esomeprazole | 20 mg | Non-formulary |
Pantoprazole | 40 mg | Restricted in SEL |
Rabeprazole | 20 mg | Non-formulary |