Product Details
AA-Lansoprazole-Amoxicillin-Clarithromycin
Lansoprazole + Clarithromycin + Amoxicillin30 mg + 500 mg + 500 mg
Tablet/Capsule Pack
DIN/PIN/NPN
02470780
Manufacturer
A A Pharma Inc.
Formulary Listing Date
2018-09-27
Unit Price
67.9100
Amount MOH Pays
67.9100
Coverage Status
Limited Use Product
ODB Formulary Therapeutic Classification
Therapeutic Note
NO
ATC Code
A02BD07
Interchangeable Products
| DIN/ PIN/ NPN | Brand name | Unit Price | Amount MOH pays |
|---|---|---|---|
| 02238525 | Hp-PAC | NA | NA |
| 02470780 | AA-Lansoprazole-Amoxicillin-Clarithromycin | 67.9100 | 67.9100 |
LU Clinical Criteria
| LU Code | Auth. Period | Clinical Criteria |
|---|---|---|
| 306 | 1 year | For the treatment of H. pylori-positive peptic ulcers where H. pylori is documented, by serology, breath test or endoscopy, for a course of up to 14 days. Maximum duration: 14 days. |
| 307 | 1 year | For the retreatment of H. pylori-positive peptic ulcers where H. pylori recurrence or persistence is documented, by breath test or endoscopy, for a course of up to 14 days. Maximum duration: 14 days (after a four-week period has elapsed since the end of the previous treatment). Retreatment decisions should be based upon positive symptoms and positive endoscopy or positive urea breath test. Retreatment should not be based on a positive serology test, as serology tests may remain positive indefinitely. An alternative antibiotic regimen is recommended when initial therapy fails due to concerns of antimicrobial resistance. |