H. pylori infection

1. Who to treat?

    1. peptic ulcer

    2. long term anti acid use

    3. cancer risk factor

    4. more than 1 year use of anti acid

2. Test:

    1. Urea Breath Test (UBT)

    2. or Fecal H. pylori Antigen (no use of Ab in last month and no use of anti acid in last 2 weeks)

    3. or Serum H. pylori IgG

3. Triple therapy:

    1. Cap esomeprazole 40 mg bid #28

    2. tab clarithromycin 500 mg bid #28

    3. Cap amoxicillin 500 mg 2tabs bid #60

        1. or tab metronidazole 500 mg bid #28

4. Quadruple therapy:

    1.  Cap amoxicillin 500 mg 2tabs bid #60

    2. Cap esomeprazole 40 mg bid #28

    3. tab metronidazole 500 mg bid #28

        1. tab clarithromycin 500 mg bid #28

    4. tab bismuth sub citrate 2 tab bid #60

5. 2nd line treatment: for 2 weeks

    1. Cap amoxicillin 500 mg 2 tab bid

    2. Cap levofloxacin 500 mg bid

        1. or cap rifampin 150 mg bid

        2. or Tab furazolidone 100 mg bid

    3. Cap esomeprazole 40 mg bid

6. Side effects:

    1. clarithromycin: bitter taste, skin rash

    2. Metronidazole: iron taste

    3. Bismuth: dark stool

    4. Amoxicillin: pseudomembranous colitis, diarrhea

    5. tetracycline: skin rash, photosensitivity