Drug formulary

Question 1

Drugs used to treat peptic ulcer disease ?

Answer 1

if positive H. Pylori test - ( positive carbon- 13 urea test ) + not associated with NSAID use - needs eradication therapy.

eradication therapy - first line ( 7 day PPI + 2 antibiotics - triple therapy ).

PPI

0 Lansoprazole 30mg 
0 Omeprazole 20-40 mg
0 Esomeprazole 20mg
0 Pantoprazole 40mg
0 Rabeprazole 20mg 

2 Antibiotics

1. Amoxicillin 1g twice daily +
2. either Clarithromycin 500mg twice daily or Metronidazole 400mg twice daily.

Allergy to penicillin

1. Clarithromycin 250 mg twice daily +
2. metronidazole 400mg twice daily.

Allergy + previous exposure to Clarithromycin.

1. Metronidazole 2 times a day 400 mg + Tetracycline Hydrochloride 500mg 4 times a day.

0 Positive H. Pylori + associated with NSAID use

Full dose PPI for 2 months (acid suppression ) then eradication therapy after PPI course finished.

0 Negative H. Pylori - proven ulcer

Full dose PPI for 4-8 weeks - dependent on clinical judgement.

After 6 -8 weeks repeat endoscopy + H. Pylori re testing - after starting decided therapy - check for ulcer healing and eradication status .

if H. Pylori present - 2nd line eradication therapy.

If endoscopy has healed - give low dose PPI.
0 if they are on a still taking a non -avoidable NSAID drug or aspirin - consider lowering dose + offering long term Gastroprotection with acid suppression.
OR switching to alternative to NSAID - paracetamol or COX 2 inhibitor.
0 Switching to antiplatelet treatment.

If not healed

0 check adherence
0 switch to alternative acid suppression ( H2RA) if they were taking PPI.
0 consider need for long term acid suppression therapy.

if recurrent symptoms after first line eradication

0 offer Carbon 13 urea test - first line , stool antigen test - 2nd line if 1st not available .

positive result - 2nd line eradication therapy.

Question 2

What do you if a patient was negative upon H. Pylori testing and was given PPI therapy —-> but has recurring symptoms ?

Answer 2

Check adherence - reinforce lifestyle advice.

2. check for other causes of ulceration e.g malignancy , failure to detect H. Pylori, (still using NSAID or Ulcer inducing drug) , Crohns’s disease , Zollinger - Ellison syndrome.

Question 3

What is second line H. Pylori eradication therapy ?

Answer 3

1. PPI + Amoxicillin 1g + ( Metroniazole or Clarithrmycin - use the one which was not used in 1st line ) - 7 days

PREVIOUS EXPOSURE TO METRONIDAZOLE AND CLARITHROMYCIN - 7-10 day triple

PPI + Amoxcillin + Tetracycline Hydrochloride

if tetracycline not apporiate :

Quinolone used : e.g Levoflaxin 250 mg.

ALLERGY TO PENICILLIN - 7- 10 day

PPI + Metronidazole + Quinolone

ALLERGY + EXPOSURE TO QUINOLONE

A PPI + tripotassium dicitratobismuthate 240 mg four times a day + metronidazole + tetracycline hydrochloride