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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 

For initial treatment, a one-week triple-therapy regimen that comprises a proton pump inhibitor, clarithromycin, and either amoxicillin or metronidazole can be used.

If a patient has been treated with a macrolide for other infections, a regimen containing a proton pump inhibitor, amoxicillin and metronidazole is preferred for initial therapy.

These regimens eradicate H. pylori in about 85% of cases. There is usually no need to continue antisecretory treatment (with a proton pump inhibitor or H2-receptor antagonist), however, if the ulcer is large, or complicated by haemorrhage or perforation, then antisecretory treatment is continued for a further 3 weeks.

Consult BNF and the Antibiotic Policy for further details and dosing information.

Treatment failure usually indicates antibacterial resistance or poor compliance - consult gastroenterologist for advice

01.03.01  Expand sub section  H2-receptor antagonists
Ranitidine
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Formulary Tablets
Effervesent tablets
Syrup
Injection 
   
01.03.02  Expand sub section  Selective antimuscarinics
01.03.03  Expand sub section  Chelates and complexes to top
Sucralfate (Antepsin®)
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Formulary Tablets
Suspension

note Following reports of bezoar formation associated with sucralfate, caution is advised in seriously ill patients, especially those receiving concomitant enteral feeds or those with predisposing conditions such as delayed gastric emptying

 
   
Tripotassium Dicitratobismuthate (De-Noltab®)
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Formulary Restricted Item  H.pylori eradication only 
   
01.03.04  Expand sub section  Prostaglandin analogues
01.03.05  Expand sub section  Proton pump inhibitors (PPIs)
Omeprazole
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First Choice Capsules
Injection Restricted Item Only for use in ventilated patients to prevent ventilator associated pneumonia and in patients who have received an endoscopic intervention for upper gastro-intestinal bleeding.

Swallowing difficulties: Patients can open the capsule and swallow the contents with half a glass of water or mix the contents in fruit juice or non-carbonated water. Patients should be advised that the dispersion should be taken within 30 minute and always be stirred just before drinking and rinsed down with half a glass of water. 
Lansoprazole
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Formulary Capsules
Orodispersible tablets - first choice for patients with enteral feeding tubes 
   
01.03.06  Expand sub section  Other ulcer-healing drugs
 ....
 Non Formulary Items
Cimetidine

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Non Formulary
 
Esomeprazole

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Non Formulary
 
Famotidine

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Non Formulary
 
Misoprostol  (Cytotec®)

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Non Formulary
 
Nizatidine

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Non Formulary
 
Pantoprazole

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Non Formulary
 
Rabeprazole

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Non Formulary
 
  
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
click to search medicines.org.uk
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
Cancer Drugs Fund
Cancer Drugs Fund
NHSE
NHS England
Homecare
Homecare
CCG
CCG

Traffic Light Status Information

Status Description

Amber

Drugs designated amber are suitable for shared care arrangements under a shared care protocol. Prescribing may be transferred from secondary to primary care once the patient is stabilised and agreed shared care arrangements have been established. Alternatively primary care may initiate under the supervision of secondary care if this option is given in the shared care document. It is recommended that shared care arrangements should be drawn up following local discussion and agreement by prescribing parties.   

Black

These products have been reviewed by the GM Joint Formulary Group and have been deemed not suitable for prescribing for adults in primary or secondary care within Greater Manchester. These decisions have been made on the basis of safety, efficacy and cost-effectiveness of the products.  

Green

Not used   

Green 1

Drugs designated green1 are suitable for initiation and ongoing prescribing within primary care.   

Green 2

Drugs designated green2 can be initiated by primary care following written or verbal advice from a specialist and then be subsequently safely prescribed in primary care with little or no monitoring required.  

Green 3

Drugs designated green3 are suitable for on-going prescribing within primary care after specialist initiation and an initial review (unless specified) in secondary care. Little or no monitoring is required.  

Grey

Not suitable for routine prescribing but may be suitable for a defined patient population. Whilst prescribers should think very carefully before prescribing or recommending any of the products on the grey list, there may be exceptional instances when the use of one of these products is necessary for a particular patient.   

Red

Drugs designated red are considered to be specialist medicines and prescribing responsibility for these medicines should normally remain with the consultant or specialist clinician. These drugs should not be initiated or prescribed in primary care. It is recommended that the supply of these specialist medicines should be organised via the hospital pharmacy, this may include arranging for supply via a home care company.   

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