Home' Australian Pharmacist : Australian Pharmacist August 2013 Contents Australian Pharmacist August 2013 I © Pharmaceutical Society of Australia Ltd.
COUNSELLING IN PRACTICE
1. In addition to being associated with
PUD, H. pylori infection increases the
risk of which ONE of the following
a) Clostridium difficile associated
b) Gastro-oesophageal reflux disease.
d) Gastric cancer.
2. Which ONE of the following
PPI regimens would be MOST
appropriate for inclusion in a
H. pylori eradication regimen?
a) Esomeprazole 40 mg orally twice daily.
b) Lansoprazole 15 mg orally twice daily.
c) Omeprazole 40 mg orally once daily.
d) Pantoprazole 40 mg IV twice daily.
e) Esomeprazole 20 mg orally twice daily.
3. In which ONE of the following
scenarios would a 7-day regimen
of omeprazole (20 mg BD) with
clarithromycin (500 mg BD) and
metronidazole (400 mg BD) be the
MOST appropriate treatment?
a) First line for an NSAID related GU in a
75-year-old female smoker.
b) First line for an H. pylori related DU in
a 45-year-old male with immediate
c) First line for SRMD in a 62-year-old
male who lives in a remote area and is
taking warfarin for atrial fibrillation.
d) First line for an H. pylori related
DU in a 72-year-old male who had
clarithromycin for an RTI six weeks ago.
e) Second line for an H. pylori related DU
in a 61-year-old woman treated with
the same regimen one month ago.
4. Continuation of a PPI for four to
eight weeks after completion of
eradication therapy would be most
strongly indicated in which ONE of
the following scenarios?
a) Whenever eradication therapy involves
b) Patients with a perforated ulcer.
c) Male patients.
d) Patients who had been treated with
clarithromycin in the previous 6
e) Patients aged under 65 years.
5. Recurrence of symptoms after
completion of eradication may:
a) suggest eradication was not
b) warrant medical review.
c) occur where adherence and
persistence with treatment was
d) result in retesting for H. pylori.
e) All of the above.
• GESA Consumer Information –
Helicobacter pylori. At: www.gesa.org.
• JAMA Patient Page – Helicobacter
pylori. At: http://jama.jamanetwork.
• MedlinePlus – Peptic Ulcer. At: www.
1. McColl KEL. Helicobacter pylori Infection N Engl J Med
2. Management of Infection Guidance for Primary Care. British
Infection Association/Health Protection Agency. At: www.
(Accessed 18 Jun 2013)
3. Therapeutic Guidelines – Gastrointestinal. Therapeutic
Guidelines, Melbourne 2013.
4. Braden B. Diagnosis of Helicobacter pylori infection. BMJ
5. Khalili H, Huang ES, Jacobson BC, CA Camargo Jr, Feskanich D,
Chan AT. Use of proton pump inhibitors and risk of hip fracture
in relation to dietary and lifestyle factors: a prospective cohort
study. BMJ 2012;344:e372.
6. Luk CP, Parsons R, Lee YP, Hughes JD. Proton pump inhibitor-
associated hypomagnesemia: what do the FDA data tell us?
Ann Pharmacother 2013 Jun;47(6):773–80 .
Key counselling points
H.pylori infection is common, affecting
around one in three Australians.
Treatment regimens for H. pylori, such
as that prescribed can eradicate the
bacteria causing PUD in 8–9 out of
every 10 patients. By doing so the risk
of recurrent PUD falls to almost zero.
Treatment may also reduce the risk of
certain gastrointestinal cancers.
Self-help measures such as reducing
exposure to other risk factors,
for example, excess alcohol intake and
cigarette smoking also contribute to
reducing the risk of recurrence.
Avoiding high-risk medications such
as systemic NSAIDs (including those
available over the counter) is strongly
recommended, other pharmacological
and non-pharmacological approaches
to managing pain and inflammation
should be optimised to help
Adherance with the eradication
regimen is of the utmost importance.
Poor adherence and persistence is the
most common reason for treatment
failure and is likely to result in the need
for a second line treatment regimen,
which often involves more drugs,
which are frequently poorly tolerated
and may need to be given for a longer
period of time.
Whilst eradicating H. pylori may be
associated with adverse effects, these
are usually mild and the benefits
of treatment invariably outweigh
Persistence or re-emergence
of symptoms may suggest that
eradication has not been successful
and should prompt a return to
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