H. pylori — 14 days (when bismuth is not available): Esomeprazole, Amoxicillin, Clarithromycin, Metronidazole, Bismuth quadruple (first choice where bismuth is available, and in penicillin allergy)
After treatment: Esomeprazole (ulcer healing)
Advice and when to refer
Test of cure: Urea breath test or stool antigen ≥ 4 wk after antibiotics and ≥ 2 wk off PPI (Maastricht VI 2022)
Refer for endoscopy: New dyspepsia over 50–60 y, weight loss, difficulty swallowing, vomiting, anaemia or GI bleeding; refractory or multiple ulcers with diarrhoea → fasting gastrin off PPI (Zollinger–Ellison) (ACG/CAG 2017, latest)
Investigations
First visit
H. pylori test (urea breath test, stool antigen or biopsy) — Off PPI for 2 weeks and antibiotics for 4 weeks before testing.
CBC — Anaemia.
Only if indicated
Upper GI endoscopy — Alarm features, age over 60, or gastric ulcer (biopsy and repeat to confirm healing).
Fasting serum gastrin — Multiple or refractory ulcers with diarrhoea (off PPI).
Follow-up and monitoring
Test of cure — Urea breath test or stool antigen at least 4 weeks after treatment.
Locked
The adult dose for each drug
Indian brand names for each drug, with a link to buy
ICU Decoded — original critical-care and internal-medicine pathways by
Dr Javed Akhtar, each cited to a current guideline. For education and quick
reference; verify every dose against local protocols before prescribing.