Drug reference
Gastro-oesophageal reflux disease ▶BY MOUTH ▶Child 6–11 years: 5–10 mL, to be taken after meals and at bedtime ▶Child 12–17 years: 10–20 mL, to be taken after meals and at bedtime ▶Adult: 10–20 mL, to be taken after meals and at bedtime
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Flavours of oral liquid formulations may include aniseed or peppermint.
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→Appendix 1: calcium salts. sodium bicarbonate
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There can be variation in the licensing of different medicines containing the same drug. Oral suspension Gastro-intestinal system ELECTROLYTES: May contain Sodium ▶Acidex (Pinewood Healthcare) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Acidex oral suspension aniseed sugar-free | 500 ml G £2.56 DT = £1.95 Acidex oral suspension peppermint sugar-free | 150 ml G £1.21 DT = £2.58 sugar-free | 500 ml G £2.56 DT = £1.95 ▶Entrocalm Heartburn and Indigestion Relief (Galpharm International Ltd) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Entrocalm Heartburn and Indigestion Relief oral suspension sugar-free | 150 ml G s DT = £2.58 ▶Gaviscon (Reckitt Benckiser Healthcare (UK) Ltd) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Gaviscon Original Aniseed Relief sugar-free | 150 ml G £2.58 DT = £2.58 sugar-free | 300 ml G £4.33 DT = £4.33 sugar-free | 600 ml G £7.11 DT = £7.11 ▶Gaviscon Liquid Relief (Reckitt Benckiser Healthcare (UK) Ltd) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Gaviscon Peppermint Liquid Relief sugar-free | 150 ml G £2.58 DT = £2.58 sugar-free | 300 ml G £4.33 DT = £4.33 sugar-free | 600 ml G £7.11 DT = £7.11 ▶Peptac (Teva UK Ltd) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Peptac liquid peppermint sugar-free | 500 ml G £1.95 DT = £1.95 Peptac liquid aniseed sugar-free | 500 ml G £1.95 DT = £1.95 ▶Rennie (Bayer Plc) Calcium carbonate 16 mg per 1 ml, Sodium bicarbonate 26.7 mg per 1 ml, Sodium alginate 50 mg per 1 ml Rennie Liquid Heartburn Relief oral suspension sugar-free | 150 ml G £2.52 DT = £2.58 sugar-free | 250 ml G £3.47 4.4 Helicobacter pylori infection Helicobacter pylori infection Description of condition 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. The use of non-steroidal anti-inflammatory drugs (NSAIDs) may have an additive effect if there is co-existent H. pylori infection, further increasing the risk of peptic ulceration and bleeding. H. pylori is also associated with acute and chronic gastritis, gastric cancer, and gastric mucosa associated lymphoid tissue (MALT) lymphoma. Aims of treatment Treatment aims to eradicate H. pylori, reduce the risk of peptic ulcer disease, ulcer bleeding and gastric malignancy, and the recurrence of gastritis and peptic ulcers. Testing for Helicobacter pylori g The presence of H. pylori should be confirmed before starting eradication treatment (’test and treat’ strategy). h Testing for H. pylori is recommended in the following patients in line with Public Health England (PHE) Guidance: . Patients with uncomplicated dyspepsia and no alarm symptoms who are unresponsive to lifestyle changes and antacids, following a single one month treatment course with a proton pump inhibitor; . Patients considered to be at high risk of H. pylori infection (such as older people, individuals of North African ethnicity, and those living in a known high risk area) should be tested for H. pylori infection first, or in parallel with a course of a proton pump inhibitor; . Previously untested patients with a history of peptic ulcers or bleeds; . Prior to initiating NSAIDs in patients with a prior history Gastro-intestinal system of peptic ulcers or bleeds; . Patients with unexplained iron-deficiency anaemia after endoscopic investigation has excluded malignancy, and other causes have been investigated. g The urea (13C) breath test p. 91, Stool Helicobacter Antigen Test (SAT), or laboratory-based serology where its performance has been locally validated, are recommended for the diagnosis of gastro-duodenal infection with H. pylori. h PHE advise that the urea (13C) breath test and SAT should not be performed within 2 weeks of treatment with a proton pump inhibitor or within 4 weeks of antibacterial treatment, as this can lead to false negatives. g Office based serological tests for H. pylori are not recommended due to their inadequate performance. h Retesting for Helicobacter pylori g In patients with functional dyspepsia, routine retesting after H. pylori eradication is not recommended. Retesting may be considered in patients who would value the information. h PHE recommend retesting in the following circumstances: . If compliance is poor, or there are high local resistance rates; . The patient has persistent symptoms and the initial test was performed within 2 weeks of treatment with a proton pump inhibitor, or within 4 weeks of antibacterial treatment; . In patients with an associated peptic ulcer, MALT lymphoma, or after resection of an early gastric carcinoma; . Patients taking aspirin without concomitant treatment with a proton pump inhibitor; . Patients with severe persistent or recurrent symptoms, particularly if not typical of gastro-oesophageal reflux disease. Retesting should be performed at least 4 weeks (ideally 8 weeks) after treatment. In patients requiring gastric acid suppression H2-receptor antagonists p. 78 should be used. g The urea (13C) breath test should be used for retesting. h Drug treatment Treatment of H. pylori usually involves a triple-therapy regimen that comprises a proton pump inhibitor and 2 antibacterials. PHE advise that the choice of antibacterials should take into consideration the patient’s antibacterial treatment history, as each additional course of clarithromycin, metronidazole, or quinolone increases the risk of resistance. g Consider referral to a specialist in patients who remain H. pylori positive after second-line eradication therapy. h PHE also advise that patients should be referred for an endoscopy, culture and susceptibility testing if the choice of antibacterial treatment is reduced due to hypersensitivity, there are known high local resistance rates, or patients have previously received treatment with clarithromycin, metronidazole, and a quinolone. PHE advise that if diarrhoea develops, Clostridioides difficile infection should be considered and the need for treatment reviewed. g The importance of adherence to treatment should be discussed and emphasised to the patient. h Choice of treatment regimen No penicillin allergy . Oral first line for 7 days: g A proton pump inhibitor, plus amoxicillin p. 579, and either clarithromycin p. 567 or metronidazole p. 572 (treatment choice should take into account previous treatment with clarithromycin or metronidazole). h . Oral second line for 7 days (if ongoing symptoms after first line treatment): g A proton pump inhibitor, plus amoxicillin, and either clarithromycin or metronidazole (whichever was not used first line). h . Oral alternative second line for 7 days (for patients who have received previous treatment with clarithromycin and metronidazole): g A proton pump inhibitor, plus amoxicillin, and tetracycline p. 600 [unlicensed] (or, if a tetracycline cannot be used, levofloxacin p. 592 [unlicensed]). h . Oral third line for 10 days on specialist advice only in line with PHE Guidance: A proton pump inhibitor, plus bismuth subsalicylate p. 77 [unlicensed], and either 2 antibacterials from those mentioned above not previously used, or rifabutin p. 608 [unlicensed], or furazolidone [unlicensed]. Penicillin allergy . Oral first line for 7 days: g A proton pump inhibitor, plus clarithromycin, and metronidazole. h . Oral alternative first line for 7 days (for patients previously treated with clarithromycin): g A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed]. h . Oral second line for 7 days (if ongoing symptoms after first line treatment in patients who have not received previous treatment with a fluoroquinolone): g A proton pump inhibitor, plus metronidazole, and levofloxacin [unlicensed]. h . Oral alternative second line for 7 days (in patients who have received previous treatment with a fluoroquinolone): g A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], plus metronidazole, and tetracycline [unlicensed]. h . Oral third line for 10 days on specialist advice only in line with PHE Guidance: A proton pump inhibitor, plus bismuth subsalicylate [unlicensed], and either rifabutin [unlicensed] or furazolidone [unlicensed]. For any advice, consult a local microbiologist or the Helicobacter Reference Laboratory at: www.gov.uk/guidance/ gbru-reference-and-diagnostic-services. For additional information on the management of patients with H. pylori infection and peptic ulcer disease or dyspepsia, see Peptic ulcer disease p. 76 and Dyspepsia p. 72. Useful Resources Gastro-oesophgeal reflux disease and dyspepsia in adults: investigation and management. National Institute for Health and Care Excellence. NICE guideline 184. September 2014, updated October 2019. www.nice.org.uk/guidance/cg184 Test and treat for Helicobacter pylori (HP) in dyspepsia; Quick reference guide for primary care: For consultation and local adaptation. Public Health England. July 2017, updated August 2019. www.gov.uk/government/publications/helicobacter-pylori- diagnosis-and-treatment DIAGNOSTIC AGENTS
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Medicines for Children leaflet: Gaviscon for gastro-oesophageal reflux disease www.medicinesforchildren.org.uk/gaviscon- gastro-oesophageal-reflux-disease
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10–20 mL, to be taken after meals and at
First-line fragment. Read the complete Indications and Dose section above.
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