# Peptic ulcer disease - Category: chronic - Review status: reviewed (every claim checked against a document named on this page) - Sources: VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK (vonoprazan; amoxicillin; clarithromycin) US prescribing information, sections 2.1 and 2.2 (DailyMed SetID 0cb2ee04-8581-46c8-a781-7be170ab5c86): "In the morning, take 20 mg of vonoprazan (one oval pale red tablet), 1,000 mg of amoxicillin (two yellow capsules), and 500 mg of clarithromycin (one oval white tablet)", with the same three again in the evening, the pack being "given with or without food, for 14 days". The dual pack is the same 20 mg of vonoprazan twice daily with amoxicillin morning, mid-day and evening. · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · NICE Guideline CG184 (2014) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (pantoprazole monograph) · US FDA label, VOQUEZNA (vonoprazan) tablets, Phathom Pharmaceuticals (DailyMed) · Peptic ulcer disease - disease-level clinical article (peptic-ulcer-disease-full.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph, H. pylori eradication regimen) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bismuth subcitrate monograph, H. pylori eradication regimen) · Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph: avoid clarithromycin where local resistance is ≥15%) · Helicobacter pylori infection - disease-level clinical article (h-pylori-full.txt): "Commonly recommended regimens include 14-day bismuth quadruple therapy" - Verified date: 2026-08 ## Verified against - VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK (vonoprazan; amoxicillin; clarithromycin) US prescribing information, sections 2.1 and 2.2 (DailyMed SetID 0cb2ee04-8581-46c8-a781-7be170ab5c86): "In the morning, take 20 mg of vonoprazan (one oval pale red tablet), 1,000 mg of amoxicillin (two yellow capsules), and 500 mg of clarithromycin (one oval white tablet)", with the same three again in the evening, the pack being "given with or without food, for 14 days". The dual pack is the same 20 mg of vonoprazan twice daily with amoxicillin morning, mid-day and evening. - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (pantoprazole monograph) - Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) - US FDA label, VOQUEZNA (vonoprazan) tablets, Phathom Pharmaceuticals (DailyMed) - Peptic Ulcer Disease - disease-level clinical article (peptic-ulcer-disease-full.txt) - Peptic ulcer disease - disease-level clinical article (peptic-ulcer-disease-clinical.txt) - Egyptian National Drug Formulary - Antimicrobial 2023 (H. pylori eradication regimen, amoxicillin monograph) ## Treatment metadata - Omeprazole — 20 mg — oral.solid - Pantoprazole — 40 mg — oral.solid - Referral & safety-netting (no drug therapy) - Omeprazole — 20 mg — oral.solid - Bismuth subcitrate + Metronidazole + Tetracycline — oral.solid - Famotidine — 20 mg — oral.solid - Omeprazole — 20 mg — oral.solid - Clarithromycin — 500 mg — oral.solid - Bismuth subcitrate — oral.solid - Amoxicillin — 1000 mg — oral.solid - Vonoprazan — 20 mg — oral.solid - Omeprazole — 20 mg — oral.solid - Metronidazole — 500 mg — oral.solid - Clarithromycin — 500 mg — oral.solid ## Complete treatment card ```text PEPTIC ULCER DISEASE Sources: VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK (vonoprazan; amoxicillin; clarithromycin) US prescribing information, sections 2.1 and 2.2 (DailyMed SetID 0cb2ee04-8581-46c8-a781-7be170ab5c86): "In the morning, take 20 mg of vonoprazan (one oval pale red tablet), 1,000 mg of amoxicillin (two yellow capsules), and 500 mg of clarithromycin (one oval white tablet)", with the same three again in the evening, the pack being "given with or without food, for 14 days". The dual pack is the same 20 mg of vonoprazan twice daily with amoxicillin morning, mid-day and evening. · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 · NICE Guideline CG184 (2014) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (pantoprazole monograph) · US FDA label, VOQUEZNA (vonoprazan) tablets, Phathom Pharmaceuticals (DailyMed) · Peptic ulcer disease - disease-level clinical article (peptic-ulcer-disease-full.txt) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (omeprazole monograph, H. pylori eradication regimen) · Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (bismuth subcitrate monograph, H. pylori eradication regimen) · Egyptian National Drug Formulary - Antimicrobial 2023 (clarithromycin monograph: avoid clarithromycin where local resistance is ≥15%) · Helicobacter pylori infection - disease-level clinical article (h-pylori-full.txt): "Commonly recommended regimens include 14-day bismuth quadruple therapy" Review status: REVIEWED against VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK (vonoprazan; amoxicillin; clarithromycin) US prescribing information, sections 2.1 and 2.2 (DailyMed SetID 0cb2ee04-8581-46c8-a781-7be170ab5c86): "In the morning, take 20 mg of vonoprazan (one oval pale red tablet), 1,000 mg of amoxicillin (two yellow capsules), and 500 mg of clarithromycin (one oval white tablet)", with the same three again in the evening, the pack being "given with or without food, for 14 days". The dual pack is the same 20 mg of vonoprazan twice daily with amoxicillin morning, mid-day and evening., Egyptian National Drug Formulary - Gastrointestinal Tract 2025, Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (pantoprazole monograph), Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph), US FDA label, VOQUEZNA (vonoprazan) tablets, Phathom Pharmaceuticals (DailyMed), Peptic Ulcer Disease - disease- level clinical article (peptic-ulcer-disease-full.txt), Peptic ulcer disease - disease-level clinical article (peptic-ulcer-disease- clinical.txt), Egyptian National Drug Formulary - Antimicrobial 2023 (H. pylori eradication regimen, amoxicillin monograph) (2026-08) IS IT THIS? - reference only, to read alongside your own examination SYMPTOMS - what the patient reports (3) - Night-time pain suggests a duodenal ulcer, while bloating and fullness suggest gastric outlet obstruction [abdominal distension] - Pain worsening 15 to 30 minutes after eating points to a gastric ulcer, while pain easing with food points to a duodenal ulcer - Unexplained weight loss, worsening trouble swallowing, GI bleeding, iron deficiency anemia, recurrent vomiting, or a family history of upper GI cancer are alarm features needing urgent referral [anaemia · bleeding · difficulty swallowing · vomiting · weight loss] SIGNS - what you find (1) - Exam may show epigastric tenderness and physical signs of anemia [abdominal pain · anaemia · epigastric pain] TESTS (4) - Endoscopy is the gold standard, roughly 90% sensitive and specific, and is indicated over age 50 with new dyspepsia or at any age with alarm features - A urea breath test can confirm H. pylori eradication 4 to 6 weeks after finishing treatment - Biopsy from at least 4 to 6 sites is taken when eradication therapy fails or resistance is suspected - A gastrin level is checked when Zollinger-Ellison syndrome is suspected IF NOT THIS - what else fits (8) - Gastritis closely mimics PUD with similar upper abdominal pain and nausea from mucosal inflammation - A burning retrosternal sensation with regurgitation of food points more toward GERD than an ulcer - Weight loss, melena, recurrent vomiting, or signs of spread elsewhere should raise concern for gastric cancer - Pain that is severe, persistent, and worse lying flat, in a patient with alcohol use or gallstones, favors pancreatitis - Sharp intermittent pain brought on by fatty meals points toward biliary colic rather than an ulcer - Fever, a positive Murphy sign, and leukocytosis distinguish cholecystitis from simple biliary colic - Epigastric pain with nausea in a high-risk patient, especially with dizziness or breathlessness, should raise concern for inferior wall MI - Pain after eating in an older patient with atherosclerosis risk factors and weight loss suggests chronic mesenteric ischemia Score Glasgow-Blatchford score - Does this upper-GI bleed need admission and treatment? Source StatPearls "Peptic Ulcer Disease" - disease-level clinical article Status traced to the source above !! 3 ALTERNATIVE REGIMENS BELOW - A and B and C. Give every drug of ONE regimen. !! Do NOT combine the regimens with each other. !! A: Omeprazole + Bismuth subcitrate + Metronidazole + Tetracycline !! B: Omeprazole + Clarithromycin + Amoxicillin !! C: Omeprazole + Metronidazole + Clarithromycin Rx: First line | If taking clopidogrel | Main treatment | H. pylori eradication - Regimen A (bismuth quadruple) | H. pylori eradication - Regimen B (clarithromycin triple with amoxicillin) | H. pylori eradication - Regimen C (clarithromycin triple with metronidazole) FIRST LINE 1. OMEPRAZOLE [1st line] Adult 20 mg once daily in morning before food (40 mg daily for severe/duodenal ulcer) x 4-8 weeks Peds 0.7-1.4 mg/kg once daily (max 40 mg/day) Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 Why First-line PPI for mucosal healing in gastric and duodenal ulcers Caution Test for H. pylori infection before or after treatment (PPIs cause false negative test). Long-term PPI use increases risk of hypomagnesaemia, fractures, and C. difficile. Re-evaluate if symptoms persist after 4-8 weeks. 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) IF TAKING CLOPIDOGREL 2. PANTOPRAZOLE [1st line] Adult 40 mg once daily in morning before breakfast x 4-8 weeks Peds Specialist pediatric gastroenterology use only Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (pantoprazole monograph) Why Preferred PPI when co-prescribed with clopidogrel (less CYP2C19 interaction) Caution Pantoprazole has a lower risk of CYP2C19 drug interactions compared to omeprazole. May mask symptoms of gastric malignancy; rule out alarm features in >55yo. Monitor magnesium during prolonged therapy (>1 year). Pantoprazole should not be used during pregnancy or breastfeeding. Egypt PEPTOLOC 40MG 14 TAB. KAHIRA > MULT... 35.00 EGP (2.50/unit) PEPTOLOC 40MG 7 TAB. KAHIRA > MULT... 21.00 EGP (3.00/unit) PERLOC 40MG 14 F.C.TAB. EUROPEAN EGYP... 75.00 EGP (5.36/unit) PANTOLOC 40MG 14 TAB. MUP 102.00 EGP (7.29/unit) DELPANTO 40MG 14 E.C.TABS. DELTA PHARMA 84.00 EGP PANTAZOL 40MG 14 ENTERIC COATED TAB. SIGMA > SOVALUE PHARMA 104.00 EGP ZURCAL 40 MG 28 GASTRO-RESISTANT TABS. AUG PHARMA 192.00 EGP PANTOMEDRA 40 MG 28 E.C. TABS. AL ROWAD PHAR... 208.00 EGP MAIN TREATMENT - choose one 3. REFERRAL & SAFETY-NETTING (NO DRUG THERAPY) [1st line] Adult Source Peptic Ulcer Disease - disease-level clinical article (peptic-ulcer-disease-full.txt) Why Carries the referral criteria and warning signs for this condition, which apply whichever treatment is chosen. Caution RED FLAG - The alarm symptoms that should prompt urgent referral are unintentional weight loss, progressive dysphagia, overt GI bleeding, iron deficiency anemia, recurrent emesis, and family history of upper GI malignancy. RED FLAG - Refer for surgical treatment (vagotomy or partial gastrectomy) when the patient is unresponsive to medical treatment, non-compliant, or at high risk of complications. 4. FAMOTIDINE [2nd line] Adult 40 mg once daily at bedtime (or 20 mg BID) x 4-8 weeks Peds 0.5-1 mg/kg/day [child max 40 mg] (0.5-1 mg/kg/day divided BID (max 40 mg daily)) 3kg -> 1.5-3 mg/day 4kg -> 2-4 mg/day 5kg -> 2.5-5 mg/day 6kg -> 3-6 mg/day 7kg -> 3.5-7 mg/day 8kg -> 4-8 mg/day 9kg -> 4.5-9 mg/day 10kg -> 5-10 mg/day 11kg -> 5.5-11 mg/day 12kg -> 6-12 mg/day 13kg -> 6.5-13 mg/day 14kg -> 7-14 mg/day 15kg -> 7.5-15 mg/day 16kg -> 8-16 mg/day 17kg -> 8.5-17 mg/day 18kg -> 9-18 mg/day 19kg -> 9.5-19 mg/day 20kg -> 10-20 mg/day 21kg -> 10.5-21 mg/day 22kg -> 11-22 mg/day 23kg -> 11.5-23 mg/day 24kg -> 12-24 mg/day 25kg -> 12.5-25 mg/day 26kg -> 13-26 mg/day 27kg -> 13.5-27 mg/day 28kg -> 14-28 mg/day 29kg -> 14.5-29 mg/day 30kg -> 15-30 mg/day 31kg -> 15.5-31 mg/day 32kg -> 16-32 mg/day 33kg -> 16.5-33 mg/day 34kg -> 17-34 mg/day 35kg -> 17.5-35 mg/day 36kg -> 18-36 mg/day 37kg -> 18.5-37 mg/day 38kg -> 19-38 mg/day 39kg -> 19.5-39 mg/day 40kg -> 20-40 mg/day 41kg -> 20.5-40 mg/day (upper capped) 42kg -> 21-40 mg/day (upper capped) 43kg -> 21.5-40 mg/day (upper capped) 44kg -> 22-40 mg/day (upper capped) 45kg -> 22.5-40 mg/day (upper capped) 46kg -> 23-40 mg/day (upper capped) 47kg -> 23.5-40 mg/day (upper capped) 48kg -> 24-40 mg/day (upper capped) 49kg -> 24.5-40 mg/day (upper capped) 50kg -> 25-40 mg/day (upper capped) Choice Famotidine is the first choice here; bismuth subcitrate is a further option. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025 (famotidine monograph) Why H2-receptor antagonist alternative when PPI is contraindicated or not tolerated Caution Tolerance (tachyphylaxis) may develop with continuous use. Adjust dosage in renal impairment (CrCl < 30 mL/min). Famotidine has less potent acid suppression than PPIs. Egypt FAMOTAK 20MG 20 F.C.TAB. SEDICO 28.00 EGP (1.40/unit) GASTRODOMINA 20MG 20 TAB. MUP > ALMIRAL... 28.00 EGP (1.40/unit) ANTODINE 20 MG 30 F.C.TABS. AMOUN 60.00 EGP (2.00/unit) FAMOTIN 20MG 20TAB. MEMPHIS 40.00 EGP (2.00/unit) RANI-F 20MG 6 SACHETS PHARCO 42.00 EGP 5. BISMUTH SUBCITRATE [2nd line] Adult 240 mg (2 tablets) twice daily (or 120 mg 4 times daily) Peds Contraindicated in children under 12 years of age. Source Egyptian National Drug Formulary - Gastrointestinal Why Bismuth compound used in quadruple therapy for Helicobacter pylori eradication or peptic ulcer disease. Caution Contraindicated in children under 12 years; not recommended between 12 and 18 years. Contraindicated in severe kidney impairment. Contraindicated in pregnancy. With metronidazole and tetracycline, contraindicated with methoxyflurane - concurrent tetracycline and methoxyflurane has caused fatal renal toxicity. Egypt no Egyptian brand matched - prescribe by generic name 6. VONOPRAZAN [3rd line] Adult 20 mg twice daily as part of H. pylori eradication (with amoxicillin 1 g twice daily plus clarithromycin 500 mg twice daily, or amoxicillin 1 g three times daily) x 14 days Peds Safety and effectiveness have not been established in paediatric patients. Do not use in children. Source VOQUEZNA TRIPLE PAK and VOQUEZNA DUAL PAK (vonoprazan; amoxicillin; clarithromycin) US prescribing information, sections 2.1 and 2.2 (DailyMed SetID 0cb2ee04-8581-46c8-a781-7be170ab5c86): "In the morning, take 20 mg of vonoprazan (one oval pale red tablet), 1,000 mg of amoxicillin (two yellow capsules), and 500 mg of clarithromycin (one oval white tablet)", with the same three again in the evening, the pack being "given with or without food, for 14 days". The dual pack is the same 20 mg of vonoprazan twice daily with amoxicillin morning, mid-day and evening. Why 41 live Egyptian products. A potassium-competitive acid blocker gives faster and more sustained acid suppression than a PPI and is not dependent on CYP2C19 genotype, which matters where clarithromycin-based eradication is failing. Caution The approved label does not cover vonoprazan as monotherapy for gastric or duodenal ulcer - its ulcer role is as the acid blocker inside an H. pylori eradication regimen. Contraindicated with rilpivirine-containing products. Vonoprazan carries the same long-term class risks as a PPI: Clostridioides difficile infection, bone fracture, vitamin B12 deficiency, hypomagnesaemia, and acute interstitial nephritis. Symptomatic response does not exclude gastric malignancy - investigate alarm features regardless. Swallow whole; do not chew or crush. Not on the Egyptian National Drug Formulary - the dose above is from the US label. Egypt RAZANYPT 20 MG 20 F.C. TABS. GYPTO PHARMA 104.00 EGP (5.20/unit) TOPOPRAZAN 20 MG 30 F.C.TABS. HIKMA PHARMA 156.00 EGP (5.20/unit) XANPRAZAN 20 MG 30 F.C. TABS. MULTICARE > A... 156.00 EGP (5.20/unit) VONAFUT 20 MG 20 F.C.TABS. FUTURE PHARMA... 138.00 EGP (6.90/unit) COPADAVON 20 MG 20 F.C.TABS. COPAD EGYPT 140.00 EGP (7.00/unit) VONACIDAN 20 MG 20 F.C.TABS. AL ESRAA PHAR... 192.00 EGP (9.60/unit) VONSECA 20 MG 14 TABS. ZETA PHARM 140.00 EGP (10.00/unit) VONOGASTRIC 20 MG 20 ORAL DIS. TABS. P & C LABS 198.00 EGP H. PYLORI ERADICATION - REGIMEN A (BISMUTH QUADRUPLE) - give all together 7. OMEPRAZOLE (regimen A) [A: 1 of 2 - GIVE ALL TOGETHER] Adult 20 mg twice daily as the PPI component of this regimen, taken with a bismuth capsule after the morning and evening meal x 14 days Peds Not for children. The Egyptian formulary's bismuth subcitrate monograph lists bismuth oxide as contraindicated under 12 years old, and not recommended between 12 and 18. No paediatric dose applies to this regimen. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025, bismuth subcitrate monograph, Dosage Regimen, which states the PPI component of this regimen: "One omeprazole 20mg capsule should be taken twice a day with a bismuth capsule after the morning and evening meal for 10 days." The omeprazole monograph in the same volume gives the indication: "Eradication of Helicobacter pylori in peptic ulcer disease, in combination with antibiotics." Why The acid-suppressing backbone of the quadruple regimen. Raising intragastric pH improves the activity of the accompanying antibiotics; the formulary states the omeprazole component as part of this regimen rather than as a separate treatment. Caution Take this dose alongside the bismuth capsule, after the morning and evening meal — that is the formulary's timing for this regimen. It differs from ulcer-healing omeprazole, which is taken before food. This is the eradication dose, not the ulcer-healing dose. The omeprazole given to heal the ulcer is 20 mg once daily for 4 to 8 weeks; eradication is 20 mg twice daily for the length of the regimen. Test for H. pylori infection before or after treatment (PPIs cause false negative test). Give the full 14 days. StatPearls' H. pylori article names 14-day bismuth quadruple therapy as a commonly recommended first-line option, and the Egyptian formulary's antimicrobial volume backs a course of 10 to 14 days — triple or quadruple therapy — for eradicating H. pylori in children and adults alike. The Egyptian combined bismuth capsule is licensed for a shorter course: its own formulary entry directs 3 capsules, 4 times a day, for 10 days — so 14 days here runs longer than the pack states. Courses of 7 days or less fail more often. 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) 8. 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 Not for children. The Egyptian formulary's bismuth subcitrate monograph lists bismuth oxide as contraindicated under 12 years old, and not recommended between 12 and 18. No paediatric dose applies to this regimen. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025, bismuth subcitrate monograph. Indication: "In combination with the eradication of Helicobacter pylori in patients with active duodenal ulcer or history of duodenal ulcer disease (active or history of within the past 5 years)." Dosage form: "Capsule: 140 mg of bismuth subcitrate potassium, in combination with 125 mg of metronidazole, and 125 mg of tetracycline hydrochloride." Dose, under Dosage Regimen: "Administer three capsules 4 times a day (after meals and at bedtime) for 10 days." Why Bismuth quadruple therapy contains no clarithromycin, which is why it leads as the first-choice eradication regimen. The Egyptian formulary's clarithromycin monograph says to steer clear of clarithromycin when a patient carries risk factors for macrolide resistance — a local resistance rate of 15% or more being one of them. Regimens B and C are the clarithromycin-based alternatives, for a strain known to be clarithromycin- sensitive, or when this regimen is contraindicated. Caution CONTRAINDICATED in pregnancy and in breastfeeding. The Egyptian formulary says to avoid use in both; the tetracycline component is why eradication is deferred here rather than substituted. CONTRAINDICATED in severe kidney impairment, and in children under 12 years - not recommended between 12 and 18 years. CONTRAINDICATED with methoxyflurane — giving tetracycline hydrochloride alongside it has been reported to cause fatal kidney toxicity. Also contraindicated within two weeks of disulfiram, because of the metronidazole. Swallow the capsules whole with a full glass of water, and drink plenty of fluid with the bedtime dose especially — the formulary warns that tetracycline can otherwise irritate and ulcerate the oesophagus. Darkening of the stools is expected with bismuth and does not mean bleeding. The formulary lists stool darkening and faecal discolouration among the adverse reactions. Give apart from antacids — the formulary rates the antacid–tetracycline interaction as Risk D, meaning consider modifying therapy. Give the full 14 days. StatPearls' H. pylori article names 14-day bismuth quadruple therapy as a commonly recommended first-line option, and the Egyptian formulary's antimicrobial volume backs a course of 10 to 14 days — triple or quadruple therapy — for eradicating H. pylori in children and adults alike. The Egyptian combined bismuth capsule is licensed for a shorter course: its own formulary entry directs 3 capsules, 4 times a day, for 10 days — so 14 days here runs longer than the pack states. Courses of 7 days or less fail more often. Egypt TRIGASTCARE 120 H.G. CAPS. MULTICARE 651.00 EGP BISPYLLER 120 H.G. CAPS. HIKMA PHARMA 800.00 EGP H. PYLORI ERADICATION - REGIMEN B (CLARITHROMYCIN TRIPLE WITH AMOXICILLIN) - give all together 9. OMEPRAZOLE (regimen B) [B: 1 of 3 - GIVE ALL TOGETHER] Adult 20 mg twice daily as the PPI component of this regimen, given with clarithromycin 500 mg twice daily and amoxicillin 1 g twice daily 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. The omeprazole monograph's only paediatric figure - 0.7-1.4 mg/kg in children over 2 years - is stated for severe ulcerating esophagitis, a different indication, and is not an eradication dose. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025, omeprazole monograph. Indication: "Eradication of Helicobacter pylori in peptic ulcer disease, in combination with antibiotics." Dose, under Adult Oral Dosing: "Helicobacter pylori eradication regimens in peptic ulcer disease" - "Oral: 40 mg once daily or 20mg twice daily in association with antimicrobial agents." The monograph states no duration for the PPI component; the 10 to 14 days is the regimen's own, from the ENDF Antimicrobial 2023 amoxicillin monograph, whose H. pylori eradication regimen reads "regimen is for 10 to 14 days." Why The acid-suppressing backbone of the eradication regimen. The Egyptian formulary's H. pylori eradication regimen calls for a standard dose or a double dose of proton pump inhibitor alongside the two antibiotics, and omeprazole 20 mg twice daily fills that role here. Clarithromycin and amoxicillin without acid suppression do not eradicate H. pylori. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. The eradication dose is not the ulcer-healing dose: 20 mg twice daily for the length of the antibiotic course, against 20 mg once daily for 4 to 8 weeks to heal an ulcer. Both figures are in the same ENDF monograph. Test for H. pylori infection before or after treatment (PPIs cause false negative test). Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. 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) 10. CLARITHROMYCIN (regimen B) [B: 2 of 3 - GIVE ALL TOGETHER] Adult 500 mg twice daily for 7 to 14 days as part of an appropriate combination regimen x 14 days Peds The Egyptian formulary states its H. pylori eradication regimen as an adult regimen — the monograph indexes it to adults with H. pylori infection, and with duodenal ulcer disease, and its eradication dose sits under the adult dosing heading. No paediatric eradication figure is given. The monograph does carry a 15 mg/kg/day figure, but that is filed under general dosing for a mild-to-moderate susceptible infection — a different indication, not an eradication dose. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023, clarithromycin monograph. Indication: "Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence as a component of combination therapy (triple therapy) in adults with H. pylori infection and duodenal ulcer disease (active or 5-year history of duodenal ulcer)." Dose: "Oral: Immediate release: 500 mg twice daily for 7 to 14 days as part of an appropriate combination regimen". The same monograph narrows that course under Appropriate use: "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". Both figures are the same monograph's; the longer course applies, so every drug in this regimen is given for the same length of time. Why First-line macrolide antibiotic component of triple therapy for Helicobacter pylori eradication in peptic ulcer disease. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. Hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibiotics, or any component of the formulation; history of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin; concomitant use with cisapride, pimozide, ergot alkaloids (eg, ergotamine, dihydroergotamine), lomitapide, or HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin, simvastatin); concomitant use with colchicine in patients with renal or hepatic impairment. This is one part of a regimen, never a treatment on its own. The disease article puts first-line treatment of H. pylori peptic ulcer as a triple regimen: a proton pump inhibitor with two antibiotics. The combinations named are pantoprazole with clarithromycin, plus either metronidazole or amoxicillin, given over 7 to 14 days. The proton pump inhibitor is part of this regimen and is listed with it - give all three drugs together. Do not confuse it with the omeprazole given for ulcer healing, which is 20 mg once daily for 4 to 8 weeks; eradication is 20 mg twice daily for the length of the antibiotic course. Giving the macrolide alone breeds resistance. The Egyptian formulary limits its use for exactly this reason: where clarithromycin is the only antibacterial in the regimen, resistance to clarithromycin is likelier to develop. Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. Do not give a short course. The Egyptian formulary's clarithromycin monograph warns that combination therapy of 7 days or less carries a higher rate of treatment failure, and that current guidelines call for 10 to 14 days. Give every drug in this regimen for the same length of time. 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 11. AMOXICILLIN [B: 3 of 3 - GIVE ALL TOGETHER] Adult 1 g twice daily for 10 to 14 days, with a proton pump inhibitor and clarithromycin 500 mg twice daily 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, H. pylori eradication regimen) Why The disease article's first-line regimen is a PPI with clarithromycin plus either metronidazole or amoxicillin. The card carried the PPI and clarithromycin but no partner antibiotic - and the ENDF's clarithromycin monograph warns that where clarithromycin is the only antibacterial in the regimen, clarithromycin resistance is the more likely outcome. The added row completes it. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. Serious hypersensitivity to amoxicillin or to other beta-lactams, or any component of the formulation The ENDF states this regimen for 10 to 14 days; it is one component of a combination and is not used alone. This is one part of a regimen, never a treatment on its own. The disease article puts first-line treatment of H. pylori peptic ulcer as a triple regimen: a proton pump inhibitor with two antibiotics. The combinations named are pantoprazole with clarithromycin, plus either metronidazole or amoxicillin, given over 7 to 14 days. The proton pump inhibitor is part of this regimen and is listed with it - give all three drugs together. Do not confuse it with the omeprazole given for ulcer healing, which is 20 mg once daily for 4 to 8 weeks; eradication is 20 mg twice daily for the length of the antibiotic course. Giving the macrolide alone breeds resistance. The Egyptian formulary limits its use for exactly this reason: where clarithromycin is the only antibacterial in the regimen, resistance to clarithromycin is likelier to develop. Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. 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 H. PYLORI ERADICATION - REGIMEN C (CLARITHROMYCIN TRIPLE WITH METRONIDAZOLE) - give all together 12. OMEPRAZOLE (regimen C) [C: 1 of 3 - GIVE ALL TOGETHER] Adult 20 mg twice daily as the PPI component of this regimen, given with clarithromycin 500 mg twice daily and metronidazole 500 mg twice daily 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. The omeprazole monograph's only paediatric figure - 0.7-1.4 mg/kg in children over 2 years - is stated for severe ulcerating esophagitis, a different indication, and is not an eradication dose. Source Egyptian National Drug Formulary - Gastrointestinal Tract 2025, omeprazole monograph. Indication: "Eradication of Helicobacter pylori in peptic ulcer disease, in combination with antibiotics." Dose, under Adult Oral Dosing: "Helicobacter pylori eradication regimens in peptic ulcer disease" - "Oral: 40 mg once daily or 20mg twice daily in association with antimicrobial agents." The monograph states no duration for the PPI component; the 10 to 14 days is the regimen's own, from the ENDF Antimicrobial 2023 amoxicillin monograph, whose H. pylori eradication regimen reads "regimen is for 10 to 14 days." Why The acid-suppressing backbone of the eradication regimen. The Egyptian formulary's H. pylori eradication regimen calls for a standard dose or a double dose of proton pump inhibitor alongside the two antibiotics, and omeprazole 20 mg twice daily fills that role here. Clarithromycin and metronidazole without acid suppression do not eradicate H. pylori. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. The eradication dose is not the ulcer-healing dose: 20 mg twice daily for the length of the antibiotic course, against 20 mg once daily for 4 to 8 weeks to heal an ulcer. Both figures are in the same ENDF monograph. Test for H. pylori infection before or after treatment (PPIs cause false negative test). Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. Give the full 14 days. The Egyptian formulary allows a range for this regimen — current guidelines call for a course of 10 to 14 days, triple or quadruple therapy, for eradicating H. pylori in both children and adults — and 14 days is the duration used for every H. pylori eradication regimen here, so one duration applies throughout. 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) 13. METRONIDAZOLE [C: 2 of 3 - GIVE ALL TOGETHER] Adult 500 mg twice daily for 10 to 14 days, in place of amoxicillin, with a proton pump inhibitor and clarithromycin 500 mg twice daily 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 (H. pylori eradication regimen, amoxicillin monograph) Why The disease article names metronidazole as the alternative partner antibiotic to amoxicillin in first-line eradication - the option that matters for a penicillin- allergic patient. The ENDF prints the figure inside its H. pylori regimen; the metronidazole monograph itself carries no H. pylori indication, so that is where this dose is quoted from. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. 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 This is one part of a regimen, never a treatment on its own. The disease article puts first-line treatment of H. pylori peptic ulcer as a triple regimen: a proton pump inhibitor with two antibiotics. The combinations named are pantoprazole with clarithromycin, plus either metronidazole or amoxicillin, given over 7 to 14 days. The proton pump inhibitor is part of this regimen and is listed with it - give all three drugs together. Do not confuse it with the omeprazole given for ulcer healing, which is 20 mg once daily for 4 to 8 weeks; eradication is 20 mg twice daily for the length of the antibiotic course. Giving the macrolide alone breeds resistance. The Egyptian formulary limits its use for exactly this reason: where clarithromycin is the only antibacterial in the regimen, resistance to clarithromycin is likelier to develop. Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. Metronidazole is the partner antibiotic for a penicillin-allergic patient - it replaces amoxicillin, it does not join it. Give the full 14 days. The Egyptian formulary allows a range for this regimen — current guidelines call for a course of 10 to 14 days, triple or quadruple therapy, for eradicating H. pylori in both children and adults — and 14 days is the duration used for every H. pylori eradication regimen here, so one duration applies throughout. 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 14. CLARITHROMYCIN (regimen C) [C: 3 of 3 - GIVE ALL TOGETHER] Adult 500 mg twice daily for 7 to 14 days as part of an appropriate combination regimen x 14 days Peds The Egyptian formulary states its H. pylori eradication regimen as an adult regimen — the monograph indexes it to adults with H. pylori infection, and with duodenal ulcer disease, and its eradication dose sits under the adult dosing heading. No paediatric eradication figure is given. The monograph does carry a 15 mg/kg/day figure, but that is filed under general dosing for a mild-to-moderate susceptible infection — a different indication, not an eradication dose. AWaRe WATCH group - carries resistance cost. Egyptian EML 2025. Source Egyptian National Drug Formulary - Antimicrobial 2023, clarithromycin monograph. Indication: "Eradication of Helicobacter pylori to reduce the risk of duodenal ulcer recurrence as a component of combination therapy (triple therapy) in adults with H. pylori infection and duodenal ulcer disease (active or 5-year history of duodenal ulcer)." Dose: "Oral: Immediate release: 500 mg twice daily for 7 to 14 days as part of an appropriate combination regimen". The same monograph narrows that course under Appropriate use: "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". Both figures are the same monograph's; the longer course applies, so every drug in this regimen is given for the same length of time. Why First-line macrolide antibiotic component of triple therapy for Helicobacter pylori eradication in peptic ulcer disease. Caution NOT THE FIRST-CHOICE REGIMEN HERE. The Egyptian formulary's clarithromycin monograph advises against clarithromycin-based therapy wherever a macrolide-resistance risk factor is present — prior macrolide exposure, a local clarithromycin resistance rate of 15% or more (a figure the formulary assumes for the United States, not Egypt), or a clarithromycin triple-therapy eradication rate of 85% or less. Use the bismuth quadruple regimen, Regimen A, instead, unless the strain is known to be clarithromycin-sensitive or that regimen is contraindicated. Hypersensitivity to clarithromycin, erythromycin, any of the macrolide antibiotics, or any component of the formulation; history of cholestatic jaundice/hepatic dysfunction associated with prior use of clarithromycin; concomitant use with cisapride, pimozide, ergot alkaloids (eg, ergotamine, dihydroergotamine), lomitapide, or HMG-CoA reductase inhibitors extensively metabolized by CYP3A4 (eg, lovastatin, simvastatin); concomitant use with colchicine in patients with renal or hepatic impairment. This is one part of a regimen, never a treatment on its own. The disease article puts first-line treatment of H. pylori peptic ulcer as a triple regimen: a proton pump inhibitor with two antibiotics. The combinations named are pantoprazole with clarithromycin, plus either metronidazole or amoxicillin, given over 7 to 14 days. The proton pump inhibitor is part of this regimen and is listed with it - give all three drugs together. Do not confuse it with the omeprazole given for ulcer healing, which is 20 mg once daily for 4 to 8 weeks; eradication is 20 mg twice daily for the length of the antibiotic course. Giving the macrolide alone breeds resistance. The Egyptian formulary limits its use for exactly this reason: where clarithromycin is the only antibacterial in the regimen, resistance to clarithromycin is likelier to develop. Check the H. pylori card before picking a clarithromycin regimen here — bismuth quadruple therapy leads there too. The Egyptian formulary says to avoid clarithromycin- based therapy once local resistance reaches 15%, and the H. pylori article reserves clarithromycin triple therapy for areas with low clarithromycin resistance. Egypt's own clarithromycin resistance rate is not documented in the sources used here — 15% is only a decision threshold, and the formulary applies that figure to the United States, not Egypt. Same drug, same dose as in Regimen A. The two regimens are alternatives - you give one of them, not both. Do not give a short course. The Egyptian formulary's clarithromycin monograph warns that combination therapy of 7 days or less carries a higher rate of treatment failure, and that current guidelines call for 10 to 14 days. Give every drug in this regimen for the same length of time. Give the full 14 days. The Egyptian formulary allows a range for this regimen — current guidelines call for a course of 10 to 14 days, triple or quadruple therapy, for eradicating H. pylori in both children and adults — and 14 days is the duration used for every H. pylori eradication regimen here, so one duration applies throughout. 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 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)