Strength20 mg
Formoral.solid
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
Paediatric doseThe 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.
Dose sourceEgyptian 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."
WhyThe 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.
Cautions- 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.