PUD Treatment

NSAID; what to do for initial treatment

Stop NSAID

+

Treat with PPI (e.g. omeprazole), x 8 weeks

• Or H2RA (e.g. famotidine), or sucralfate

NSAID; how to treat if patient cannot stop NSAID

Reduce NSAID dose OR change to COX-2 selective NSAID (celecoxib)

+

Treat with PPI (e.g. omeprazole), x 8 weeks

• Or H2RA (e.g. famotidine), or sucralfate

NSAID; what to do after initial treatment of ulcer if patient must continue NSAID

NSAID + co-therapy with PPI indefinitely

• Or switch to COX-2 selective NSAID (celecoxib), or switch to a topical NSAID

H. pylori; optimized bismuth quadruple regimen

• PPI

• +

• Bismuth subcitrate/salicylate

• +

• Metronidazole

• +

• Tetracycline

H. pylori; rifabutin triple regimen

• Omeprazole

• +

• Amoxicillin

• +

• Rifabutin

H. pylori; PCAB/vonoprazan dual regimen

• Vonoprazan

• +

• Amoxicillin

H. pylori; PCAB/vonoprazan triple regimen

• Vonoprazan

• +

• Amoxicillin

• +

• Clarithromycin

Optimized bismuth quadruple regimen; PPI dosing frequency

BID

Optimized bismuth quadruple regimen; bismuth subcitrate/subsalicylate dosing frequency

QID

Optimized bismuth quadruple regimen; Tetracycline dosing frequency

QID

Optimized bismuth quadruple regimen; metronidazole dosing frequency

TID or QID