Helicobacter pylori (H. pylori) infection is one of the most common causes of peptic ulcer disease, with 95% of duodenal and 70–80% of gastric ulcers associated with it.
Treatment aims to eradicate H. pylori with a relatively short course of 2 high dose antibiotics together with a proton pump inhibitor (PPI) drug such as such as esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole sodium. Combinations of drugs may vary.
These are the options given in the British National Formulary (BNF).
No penicillin allergy
Oral first line for 7 days:
- A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (treatment choice should take into account previous treatment with clarithromycin or metronidazole).
If this fails to resolve the infection other treatments are available.
Penicillin allergy
Oral first line for 7 days:
- A proton pump inhibitor, plus clarithromycin, and metronidazole.
If this fails to resolve the infection other treatments are available.
Safety in breastfeeding.
PPI: esomeprazole, lansoprazole, omeprazole, pantoprazole, or rabeprazole sodium are largely destroyed in the mother’s stomach. Several of them have enteric coated pellets within capsules to protect them before appropriate release.
- Omeprazole (20-40mg) is only 30-40% orally bioavailable and has RID 1.1%. Preferred PPI
- Esomeprazole (20mg) is 90% orally bioavailable and has RID 2.06%. After 8 hours levels in breastmilk below level of detection
- Lansoprazole (30mg) 80% orally bioavailable (enteric coated) and is very unstable in gastric acid
- Pantoprazole (40mg) is 77% orally bioavailable (enteric coated) and RID 1% with milk levels undetectable after 5 hours
- Rabeprazole (20mg) is 52% orally bioavailable (enteric coated) and unstable in gastric acid
Antibiotics ( see https://breastfeeding-and-medication.co.uk/fact-sheet/antibiotics-and-breastfeeding)
- Amoxycillin: licensed for paediatric use. Dose 1g twice daily
- Clarithromycin: licensed for paediatric use 250mg or 500mg twice daily
- Metronidazole: 400mg twice daily. Studies show no untoward effects at this dose although there are some dated reports that it affects taste of the milk. Most babies do not react and it is widely used for anaerobic infections in the perinatal period and for dental infections.
H. Pylori infection treatment as above is compatible with continued breastfeeding. For any variations please contact me wendy@breastfeeding-and-medication.co.uk
