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