# Helicobacter pylori infection - Category: infectious - Review status: reviewed (every claim checked against a document named on this page) - Sources: Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · Helicobacter pylori Infection - disease-level clinical article (h-pylori-full.txt) · Maastricht VI Consensus 2022 · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) - Verified date: 2026-08 ## Verified against - Egyptian National Drug Formulary - Gastrointestinal Tract, bismuth subcitrate monograph - Egyptian National Drug Formulary - Antimicrobial 2023 (H. pylori eradication regimen, amoxicillin monograph) - Helicobacter pylori infection - disease-level clinical article (h-pylori-full.txt) ## Treatment metadata - Omeprazole — 20 mg — oral.solid - Bismuth subcitrate + Metronidazole + Tetracycline — oral.solid - Omeprazole — 20 mg — oral.solid - Clarithromycin — 500 mg — oral.solid - Amoxicillin — 1000 mg — oral.solid - Metronidazole — 500 mg — oral.solid ## Complete treatment card ```text HELICOBACTER PYLORI INFECTION Sources: Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · Helicobacter pylori Infection - disease-level clinical article (h-pylori-full.txt) · Maastricht VI Consensus 2022 · Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) Review status: REVIEWED against 3 sources listed above (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Most people with H pylori have no symptoms; when present, symptoms include epigastric pain, dyspepsia, nausea, vomiting, bloating, and early fullness [abdominal distension · abdominal pain · epigastric pain · indigestion · nausea · vomiting] - Less often, H pylori infection causes GI bleeding or anaemia from ongoing blood loss [anaemia · bleeding] - Symptomatic children usually report abdominal pain, nausea, vomiting, or dyspepsia [abdominal pain · indigestion · nausea · vomiting] TESTS (5) - Stool antigen testing and the urea breath test are both noninvasive with sensitivity and specificity similar to invasive tests - Blood antibody testing is not recommended for routine diagnosis because it cannot tell active from past infection - Culture is nearly 100% specific and allows susceptibility testing, useful when resistance or treatment failure is suspected - For children, samples are taken during a scope exam from two parts of the stomach lining to check tissue and urease activity for the organism - Eradication is confirmed with the urea breath test or stool antigen testing, done at least two weeks after stopping PPIs and four weeks after finishing antibiotics IF NOT THIS - what else fits (4) - Crohn disease affecting the upper GI tract is on the differential for H pylori-related symptoms - Peptic ulcer disease and NSAID-induced gastritis are also on the differential - Celiac disease is on the differential for H pylori-related symptoms - GERD and eosinophilic esophagitis are also on the differential Source StatPearls "Helicobacter Pylori" - disease-level clinical article Status traced to the source above !! 2 ALTERNATIVE REGIMENS BELOW - A and B. Give every drug of ONE regimen. !! Do NOT combine the regimens with each other. !! A: Omeprazole + Bismuth subcitrate + Metronidazole + Tetracycline !! B: Omeprazole + Clarithromycin + Amoxicillin Rx: Regimen A - bismuth quadruple | Regimen B - clarithromycin triple | Regimen C - concomitant (non-bismuth) quadruple REGIMEN A - BISMUTH QUADRUPLE - give all together 1. OMEPRAZOLE (regimen A) [A: 1 of 2 - GIVE ALL TOGETHER] Adult 20 mg twice daily as the PPI component - of the quadruple regimen on line 1, and of the triple regimen on line 2 x 14 days Peds Specialist pediatric gastroenterology regimen only Source Egyptian National Drug Formulary - Gastrointestinal Tract, bismuth subcitrate monograph, for the PPI of the bismuth quadruple: "One omeprazole 20mg capsule should be taken twice a day with a bismuth capsule after the morning and evening meal for 10 days." The 14-day course follows Helicobacter pylori Infection - disease-level clinical article (h-pylori- full.txt): "Commonly recommended regimens include 14-day bismuth quadruple therapy". Why Proton pump inhibitor that raises intragastric pH, improving the stability and activity of the accompanying antibiotics and directly suppressing H. pylori; the acid-suppressing backbone of both the quadruple and triple eradication regimens. Caution Take 30 minutes before meals. 14-day duration yields higher eradication than 7 days. The PPI runs with either regimen. If you drop to the line 2 triple therapy, omeprazole 20 mg twice daily continues alongside the clarithromycin and amoxicillin - it is not left behind on line 1. Omeprazole is the first-line PPI component of bismuth quadruple therapy. Egypt OMEGASTAZOLE 20MG 14 CAPS. RIVA PHARMA S... 18.00 EGP (1.29/unit) OMEPRAL 20MG 14 CAPS. MEMPHIS 32.00 EGP (2.29/unit) RISEK 20 MG 28 CAPS. JULPHAR 75.00 EGP (2.68/unit) OMISEC 20MG 14CAPS. THE UNITED PH... 42.00 EGP (3.00/unit) EPIRAZOLE 20MG 14CAPS. EIPICO 44.00 EGP (3.14/unit) OMEPAK 20 MG 14 CAPS. SEDICO 50.00 EGP (3.57/unit) RISEK 20 MG 14 CAPS. JULPHAR 57.00 EGP (4.07/unit) NAPIZOLE 20MG 14 CAPS. GLOBAL NAPI P... 62.00 EGP (4.43/unit) 2. BISMUTH SUBCITRATE + METRONIDAZOLE + TETRACYCLINE [A: 2 of 2 - GIVE ALL TOGETHER] Adult Three capsules four times a day, after meals and at bedtime. Each capsule contains bismuth subcitrate potassium 140 mg, metronidazole 125 mg and tetracycline hydrochloride 125 mg. Give with omeprazole 20 mg twice daily. x 14 days Peds CONTRAINDICATED under 12 years old; not recommended between 12 and 18 - specialist use only in that band. The Egyptian National Drug Formulary's bismuth subcitrate monograph (Gastrointestinal Tract, 2025) sets out these age limits in its contraindications section. Source Helicobacter pylori Infection - disease-level clinical article (h-pylori-full.txt), first-line treatment: "Current first-line treatment recommendations vary according to regional antibiotic resistance patterns. Commonly recommended regimens include 14-day bismuth quadruple therapy and concomitant (nonbismuth quadruple) therapy consisting of a proton pump inhibitor (PPI), amoxicillin, clarithromycin, and metronidazole." That is the source of the 14-day course. The Egyptian National Drug Formulary - Gastrointestinal Tract, bismuth subcitrate monograph, states the Egyptian combined capsule - "Capsule: 140 mg of bismuth subcitrate potassium, in combination with 125 mg of metronidazole, and 125 mg of tetracycline hydrochloride." - and a shorter licensed course for it: "Administer three capsules 4 times a day (after meals and at bedtime) for 10 days." with "One omeprazole 20mg capsule should be taken twice a day with a bismuth capsule after the morning and evening meal for 10 days". Both courses are stated so the guideline course and the licensed course are visible at the point of prescribing. Why Bismuth quadruple therapy leads because it contains no clarithromycin. Both the Maastricht VI/Florence consensus (2022) and the American College of Gastroenterology reserve clarithromycin triple therapy for areas where resistance to it runs at 15% or below, and the Egyptian National Drug Formulary says to avoid clarithromycin-based regimens once local resistance reaches that level. Egypt's own clarithromycin resistance rate is not documented in the cited sources, and published Egyptian figures vary widely, so the regimen that avoids clarithromycin is the safer empirical choice. Caution CONTRAINDICATED in pregnancy and breastfeeding - the tetracycline component binds fetal bone and teeth; defer eradication or refer. First-line because it avoids clarithromycin altogether. Guidelines set the cut-off for empirical clarithromycin triple therapy at 15% local resistance; Egypt’s actual rate is not documented in the cited sources. May cause dark stool and darkening of tongue (bismuth effect). Avoid alcohol due to metronidazole; take tetracycline with full glass of water. Cost: branded bismuth quadruple (BISPYLLER, TRIGASTCARE) runs 650-800 EGP. Cheaper Egyptian options exist (clarithromycin- or levofloxacin-based combinations), but local resistance makes them non-preferred first-line choices. Egypt TRIGASTCARE 120 H.G. CAPS. MULTICARE 651.00 EGP BISPYLLER 120 H.G. CAPS. HIKMA PHARMA 800.00 EGP REGIMEN B - CLARITHROMYCIN TRIPLE - give all together 3. OMEPRAZOLE (regimen B) [B: 1 of 3 - GIVE ALL TOGETHER] Adult 20 mg twice daily as the PPI component of the triple regimen - the same drug and dose as in regimen A x 14 days Peds Specialist pediatric gastroenterology regimen only Source Egyptian National Drug Formulary - Antimicrobial 2023, amoxicillin monograph, Helicobacter pylori eradication, for the shape and length of the clarithromycin triple regimen: "Different regimens containing Amoxicillin 1 g twice daily with different agents e.g clarithromycin 500 mg twice daily, a standard-dose or double-dose proton pump inhibitor, metronidazole or tinidazole 500 mg twice daily or levofloxacin 500 mg once daily. regimen is for 10 to 14 days." That monograph says "a standard-dose or double- dose proton pump inhibitor" and prints no figure for omeprazole itself; the 20 mg twice- daily figure is the one the same formulary states for omeprazole in its bismuth subcitrate monograph, quoted on the quadruple regimen. Why The PPI is not optional and it is not left behind on regimen A. Clarithromycin and amoxicillin without acid suppression do not eradicate H. pylori. Caution Same drug as the omeprazole in regimen A. You give it with whichever regimen you choose, not with both - the regimens are alternatives. Take 30 minutes before meals. 14-day duration yields higher eradication than 7 days. Egypt OMEGASTAZOLE 20MG 14 CAPS. RIVA PHARMA S... 18.00 EGP (1.29/unit) OMEPRAL 20MG 14 CAPS. MEMPHIS 32.00 EGP (2.29/unit) RISEK 20 MG 28 CAPS. JULPHAR 75.00 EGP (2.68/unit) OMISEC 20MG 14CAPS. THE UNITED PH... 42.00 EGP (3.00/unit) EPIRAZOLE 20MG 14CAPS. EIPICO 44.00 EGP (3.14/unit) OMEPAK 20 MG 14 CAPS. SEDICO 50.00 EGP (3.57/unit) RISEK 20 MG 14 CAPS. JULPHAR 57.00 EGP (4.07/unit) NAPIZOLE 20MG 14 CAPS. GLOBAL NAPI P... 62.00 EGP (4.43/unit) 4. CLARITHROMYCIN [B: 2 of 3 - GIVE ALL TOGETHER] Adult 500 mg BID combined with Omeprazole + Amoxicillin (Triple therapy) x 14 days Peds Specialist use only in children AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023, amoxicillin monograph. Dosage Regimen, Helicobacter pylori eradication, which names the regimen and the clarithromycin dose used in it: "Different regimens containing Amoxicillin 1 g twice daily with different agents e.g clarithromycin 500 mg twice daily, a standard-dose or double-dose proton pump inhibitor, metronidazole or tinidazole 500 mg twice daily or levofloxacin 500 mg once daily. regimen is for 10 to 14 days." The same monograph states under Other warnings/precautions: "Helicobacter pylori eradication: Short-term combination therapy (≤7 days) has been associated with a higher incidence of treatment failure. Current guidelines recommend 10 to 14 days of therapy (triple or quadruple) for eradication of H. pylori in pediatric and adult patients". The formulary permits 10 to 14 days. All H. pylori eradication regimens shown are given as a 14-day course. Why Clarithromycin is second-line because empirical clarithromycin triple therapy is kept for areas with low clarithromycin resistance. The Maastricht VI/Florence consensus (2022) and the American College of Gastroenterology put that limit at 15% or below, and the Egyptian National Drug Formulary says to avoid clarithromycin-based therapy once local resistance reaches that level. Egypt's own rate is not documented in the cited sources, so susceptibility testing should decide, not assumption. Caution Use only where clarithromycin susceptibility is confirmed, or where local resistance is known to be below 15%. Egypt’s clarithromycin resistance rate is not documented in the cited sources. QT prolongation and GI distress are common. Avoid with statins (CYP3A4 inhibition). All three are given together for the full course. Clarithromycin or amoxicillin on its own does not eradicate H. pylori - it fails and it selects for resistance. Egypt KAPIFECTIN 500 MG 14 F.C.TAB. EVA PHARMA 37.00 EGP (2.64/unit) LARITHROCIN 500MG 14 F.C. TABS. GLOBAL NAPI P... 40.00 EGP (2.86/unit) CAPRIVEXIN 500MG S.R. 14 F.C. TAB. HORUS FOR PHARMACEUTICAL... 58.00 EGP (4.14/unit) CLARINOTION XL 500 MG 14 F.C.TABS. RAMEDA > NOTION PHARMA 83.00 EGP (5.93/unit) KLARIMIX 500 MG 14 TAB. SIGMA > OCTOB... 144.00 EGP (10.29/unit) INFECTOCURE 500 MG 14 F.C.TABS. EGPI 156.00 EGP (11.14/unit) KLACID 500 MG 14 F.C.TABS. KAHIRA > ABBO... 257.00 EGP (18.36/unit) KLACID XL 500 MG 14 F.C.TABS. KAHIRA > ABBO... 299.00 EGP (21.36/unit) KLARIMIX 125MG/5ML SUSP. 60ML SIGMA 36.00 EGP -> ? strength differs, ? different route - not oral solid KLARIMIX 250MG/5ML SUSP. 60ML SIGMA 52.00 EGP -> ? strength differs, ? different route - not oral solid 5. AMOXICILLIN [B: 3 of 3 - GIVE ALL TOGETHER] Adult 1000 mg BID combined with Omeprazole + Clarithromycin (Triple therapy) x 14 days Peds Specialist use only in children Source Egyptian National Drug Formulary - Antimicrobial 2023 (amoxicillin monograph) Why Beta-lactam antibiotic that inhibits bacterial cell-wall synthesis; used as one of the antibiotic components of triple therapy alongside the PPI and clarithromycin, or as high-dose dual therapy, to eradicate H. pylori. Caution Contraindicated in penicillin hypersensitivity. Amoxicillin is a component of alternative triple therapy or high-dose dual therapy. All three are given together for the full course. Clarithromycin or amoxicillin on its own does not eradicate H. pylori - it fails and it selects for resistance. GI side effects are common. Egypt UNIMOX 1GM 8 F.C.TAB. HIKMA PHARMA 8.00 EGP (1.00/unit) AMOXICILLIN STADA 1000MG 12 F.C. TABS. MISR > STADA 18.00 EGP (1.50/unit) ALEMOX 1 GM 12 F.C.TABS. ALEXANDRIA 43.50 EGP (3.62/unit) OSPAMOX 1 GM 8 DISPERSABLE TAB. SANDOZ > NOVA... 11.50 EGP HICILLIN 125MG/5ML SUSP. 80ML EL NASR 3.00 EGP -> ? strength differs, ? different route - not oral solid AMOXIL FORT 250MG/5ML SUSP. 60ML MUP > SMITHKL... 5.50 EGP -> ? strength differs, ? different route - not oral solid REGIMEN C - CONCOMITANT (NON-BISMUTH) QUADRUPLE 6. METRONIDAZOLE [3rd line] Adult 500 mg twice daily, added to Regimen B's omeprazole + amoxicillin + clarithromycin to make the concomitant quadruple x 14 days Peds The ENDF states its H. pylori eradication regimen as an adult regimen; no paediatric figure is given with it, so none is carried here. Source Egyptian National Drug Formulary - Antimicrobial 2023, amoxicillin monograph. Dosage Regimen, Helicobacter pylori eradication, which sets out the regimen and its metronidazole component: "Different regimens containing Amoxicillin 1 g twice daily with different agents e.g clarithromycin 500 mg twice daily, a standard-dose or double-dose proton pump inhibitor, metronidazole or tinidazole 500 mg twice daily or levofloxacin 500 mg once daily. regimen is for 10 to 14 days." The same monograph states under Other warnings/precautions: "Helicobacter pylori eradication: Short-term combination therapy (≤7 days) has been associated with a higher incidence of treatment failure. Current guidelines recommend 10 to 14 days of therapy (triple or quadruple) for eradication of H. pylori in pediatric and adult patients". The formulary permits 10 to 14 days. All H. pylori eradication regimens shown are given as a 14-day course. Why The disease article gives concomitant non-bismuth quadruple therapy - PPI, amoxicillin, clarithromycin and metronidazole - as a first-line alternative. The card already carries the other three drugs of that regimen under Regimen B; metronidazole appears on it only inside the fixed bismuth combination, where it cannot be used this way. Caution Hypersensitivity to metronidazole, nitroimidazole derivatives, or any component of the formulation Pregnant patients (first trimester) with trichomoniasis Use of disulfiram within the past 2 weeks; use of alcohol or propylene glycol-containing products during therapy or within 3 days of therapy discontinuation Active neurological disorders; history of blood dyscrasia; hypothyroidism; hypoadrenalism Egypt DUMOZOL 500MG 20 F.C. TABS. MINA PHARM > ... 7.00 EGP (0.35/unit) ZOLGUARD 500MG 20 TAB. UNIPHARMA CO.... 9.00 EGP (0.45/unit) NITROFECTAZOLE 500 MG 20 F.C. TABS. GYPTO PHARMA 10.50 EGP (0.53/unit) FLAGICURE FORTE 500 MG 20 F.C. TAB KAHIRA 23.00 EGP (1.15/unit) TRICHOGYL 500MG 12 F.C.TAB. EL NASR 15.00 EGP (1.25/unit) FLAGELLAT FORTE 500MG 20 F.C.TABS. MUP 30.00 EGP (1.50/unit) GEDAZOLE 500MG 20 TAB. JEDCO INT. CO... 34.00 EGP (1.70/unit) METROGYPTON 500 MG 20 F.C. TABS. GYPTO PHARMA 34.00 EGP (1.70/unit) DUMOZOL 125MG/5ML SUSP. 125ML MINA PHARM > ... 5.75 EGP -> ? strength differs, ? different route - not oral solid METROZOLE 125MG/5ML SUSP. 120 ML MEMPHIS 19.50 EGP -> ? strength differs, ? different route - not oral solid Prices are indicative (dataset snapshot 2026-06); verify with the pharmacy. ``` --- Dawaa Reference is a reference for prescribers, not a medical device, and does not replace clinical judgement. [Privacy policy](/privacy)