H pylori first line — GPhC CRA MCQ

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HardGastro-intestinal TherapeuticsH pylori first lineGPhC CRA

A patient has confirmed Helicobacter pylori infection, no penicillin allergy, previous metronidazole exposure but no macrolide exposure, and local resistance information supports clarithromycin. Which first-line regimen follows NICE?

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Correct answer: C — Use seven-day PPI, amoxicillin and clarithromycin triple therapy

Use seven-day PPI, amoxicillin and clarithromycin triple therapy: NICE selects seven-day PPI-based triple therapy using allergy, previous antimicrobial exposure and local resistance; the supplied facts favour amoxicillin plus clarithromycin. Use seven-day PPI, amoxicillin and metronidazole triple therapy: Previous metronidazole exposure and favourable clarithromycin information make this the less appropriate of the first-line antibiotic choices stated. Use seven-day PPI, clarithromycin and metronidazole triple therapy: This penicillin-free combination is generally selected when amoxicillin cannot be used. Use fourteen-day PPI, amoxicillin and clarithromycin triple therapy: The cited NICE first-line regimen specifies seven days rather than automatically doubling duration. Use initial bismuth, tetracycline and metronidazole quadruple therapy: A bismuth quadruple regimen is not the first-line NICE choice under the uncomplicated susceptibility and exposure facts given.

Reference: NICE CG184: GORD and dyspepsia — H. pylori treatment: https://www.nice.org.uk/guidance/cg184/chapter/Recommendations; BNF: omeprazole: https://bnf.nice.org.uk/drugs/omeprazole/; BNF: amoxicillin: https://bnf.nice.org.uk/drugs/amoxicillin/; BNF: clarithromycin: https://bnf.nice.org.uk/drugs/clarithromycin/