Minor
Amoxicillin × Metronidazole
Penicillins with extended spectrum×Imidazole derivatives (antiprotozoal / antibacterial)
Mechanism
Target combination in triple and quadruple Helicobacter pylori eradication (Maastricht VI/Florence Consensus 2022, Kyoto Global Consensus). Synergistic antibacterial action.
Symptoms
Possible combination side effects: metallic taste (from metronidazole), nausea, diarrhoea. In some patients, disulfiram-like reaction with alcohol on metronidazole.
Management
Standard combination in H. pylori eradication (amoxicillin 1000 mg twice daily + metronidazole 500 mg three times daily + PPI or bismuth for 10–14 days). Exclude alcohol throughout the course and for 48 hours after metronidazole. If metronidazole is intolerated, alternatives: tetracycline or levofloxacin.
Check the full regimen, not just this pair
Opens the checker with these two drugs prefilled. Add the rest of the regimen and recompute additive risks.
Sources
- Maastricht VI / Florence Consensus: Management of Helicobacter pylori infection: the Maastricht VI / Florence consensus report (2022)– Gut 2022;71:1724-1762
- Минздрав РФ: Язвенная болезнь желудка и/или двенадцатиперстной кишки у взрослых. Клинические рекомендации (ID 277) (2024)– КР Минздрава РФ, ID 277, 2024