Note Doses are oral and for adults unless otherwise stated. Visit the Irish Medicines Board website for drug SPCs, dosage, contraindications, interactions, or IMF/BNF/BNFC/MIMS. See guidance on dosing in children for quick reference dosage/weight guide. Letters indicate strength of evidence range from A+ (systematic review) to D (informal opinion). Statins can interact with some antibiotics and increase the risk of rhabdomyolysis. Amiodarone and drugs which prolong the QT interval can interact with many antibiotics. Many antibiotics increase the risk of bleeding with anticoagulants. Please refer to our Drug Interactions Table for further information.
Eradication of Helicobacter pylori
Eradication is beneficial in duodenal ulcer, gastric ulcer and low grade MALTOMA, but NOT in GORD.A In non-ulcer dysepsia, 8% of patients benefit.
Triple treatment attains >85% eradication.A+
Do not use clarithromycin or metronidazole if used in the past year for any infection.A+
Managing Symptomatic Relapse
Duodenal ulcer/Gastric ulcer: Retest for helicobacter if symptomatic
Non-ulcer dyspepsia: Do not retest, treat as functional dyspepsia.
In treatment failure consider endoscopy for culture & susceptibility.C Use 14 days BD PPI plus 2 antibiotics. Consider adding bismuth salt.
250 mg BD
|All for 7 daysA
14 days in relapse or maltoma
PLUS clarithromycin AND amoxicillin
500 mg BD
|Alternative RegimensA+||PPI OR
ranitidine bismuth citrate
400 mg BD
|PLUS 2 antibiotics:|
|amoxicillin||1 g BD|
|clarithromycin A+||500 mg BD|
|metronidazole||400 mg B|