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H. pylori infection — MRCGP AKT MCQ

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EasyGastroenterologyH. pylori infectionMRCGP AKTUKMLAPARA

A 46-year-old man with dyspepsia has a positive carbon-13 urea breath test for Helicobacter pylori. He has no drug allergies and has not previously taken clarithromycin or metronidazole. Which is a NICE-recommended first-line eradication regimen?

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Correct answer: A — A PPI, amoxicillin and clarithromycin, twice daily for 7 days

NICE recommends a 7-day, twice-daily course of a PPI plus amoxicillin and either clarithromycin or metronidazole for first-line H. pylori eradication. Previous exposure to clarithromycin or metronidazole should influence antibiotic selection; neither has been used here, so option A is appropriate. Five days is shorter than the recommended course, while once-daily administration is incorrect. An H2-receptor antagonist does not replace the PPI in the recommended eradication regimen. PPI–amoxicillin dual therapy lacks the second antibiotic and is not the recommended UK first-line regimen. Treatment adherence should be emphasised because incomplete courses reduce the likelihood of successful eradication.

Reference: National Institute for Health and Care Excellence. Gastro-oesophageal reflux disease and dyspepsia in adults: investigation and management (CG184), section 1.9.4, first-line H. pylori eradication treatment. Published 2014; updated 2019. https://www.nice.org.uk/guidance/cg184/chapter/Recommendations