This combination is used for the eradication of H. pylori infection in patients with active chronic gastric and duodenal ulcers.

Amoxicillin :Amoxicillin is a penicillin-like antibiotic that kills susceptible bacteria during active growth. It works by blocking bacterial cell wall formation, which results in bacterial destruction.

Clarithromycin: Clarithromycin acts by stopping bacterial protein production. It binds to the 50S ribosomal subunit and prevents movement during protein synthesis, thereby inhibiting bacterial growth.

Rabeprazole :Rabeprazole is a proton pump inhibitor belonging to the substituted benzimidazole group. It reduces gastric acid secretion by blocking the H⁺/K⁺-ATPase enzyme in stomach parietal cells, which is the final step of acid production.

Each strip twice daily for 7 days. In case of severity, each strip twice daily for 14 days.

Geriatric patients: Elderly patients may suffer from asymptomatic renal and hepatic dysfunction. Care should be taken when administering to these patients.

Use of clarithromycin in patients receiving theophylline may increase serum theophylline levels. Interactions have also been reported between clarithromycin and several drugs including carbamazepine, cyclosporine, tacrolimus, hexobarbital, phenytoin, alfentanil, disopyramide, lovastatin, bromocriptine, valproate, terfenadine, cisapride, pimozide, and astemizole.

This combination is contraindicated in patients with known hypersensitivity to any of its components.

Adverse reactions (<3%) reported in clinical studies when all three components were used together are listed below by body system:

• Digestive system: Nausea, vomiting, diarrhoea, dark stools, dry mouth, glossitis, oral moniliasis, stomatitis, tongue discoloration
• Musculoskeletal system: Myalgia
• Nervous system: Confusion, headache, dizziness
• Skin: Skin reactions
• Urogenital system: Vaginitis, vaginal moniliasis

This combination should be used during pregnancy only if the potential benefit outweighs the possible risk to the mother. Amoxicillin is excreted in breast milk in very small amounts. Due to the risk of serious reactions in nursing infants, a decision should be made either to discontinue breastfeeding or to discontinue therapy, considering the importance of treatment for the mother.

Serious and sometimes fatal hypersensitivity (anaphylactoid) reactions have been reported with amoxicillin, especially in patients with a history of penicillin allergy. Clarithromycin should not be used during pregnancy unless no suitable alternative is available.

There is no reported experience of rabeprazole overdose. In case of amoxicillin overdose, treatment should be discontinued and supportive symptomatic care provided. Clarithromycin overdose may lead to gastrointestinal symptoms such as abdominal pain, nausea, vomiting, and diarrhoea.

Anti–H. pylori drugs

Store below 25°C, protected from light and moisture. Keep out of reach of children.