Sure Kit 14s

What Is SURE KIT?

Sure Kit is a triple therapy H. pylori eradication kit combining three complementary medicines: Lansoprazole, a proton pump inhibitor (PPI) that powerfully reduces stomach acid production, creating an environment where antibiotics can work more effectively and allowing the stomach lining to heal; Clarithromycin, a macrolide antibiotic that penetrates the stomach lining and kills H. pylori by blocking its protein synthesis; and Tinidazole, a nitroimidazole antibiotic related to Metronidazole but with a longer half-life and improved tolerability, which kills H. pylori through a different mechanism by damaging its DNA.

The use of two antibiotics with different mechanisms of action is essential; it significantly improves eradication rates and reduces the risk of treatment failure due to antibiotic resistance.

What Is It Used For?

Sure Kit is prescribed for patients in whom Helicobacter pylori (H. pylori) infection has been confirmed by a diagnostic test, such as a urea breath test, stool antigen test, or gastric biopsy, and who have peptic ulcer disease (stomach or duodenal ulcers), chronic active gastritis, or who are at risk of gastric cancer from long-standing H. pylori infection.

H. pylori is one of the most prevalent bacterial infections globally and is particularly common in Kenya, where it is a leading cause of stomach pain, bloating, nausea, early fullness, and ulcer symptoms that bring many patients to hospital and pharmacies. Successful eradication with Sure Kit heals existing ulcers, relieves symptoms, and dramatically reduces the risk of ulcer recurrence, from a 70–80% annual relapse rate without treatment to under 5% after successful eradication.

The Tinidazole-based regimen is often chosen over Amoxicillin-based triple therapy (such as Pylotrip) in patients with penicillin allergy or in regions where Amoxicillin resistance is a concern, making Sure Kit an important alternative eradication option.

Dose

All three medicines are taken TWICE daily, once in the morning and once in the evening, for the full prescribed duration (typically 7–14 days).

Complete the Full Course

Never stop the kit early, even if symptoms improve dramatically within the first few days. Incomplete courses are the most common cause of H. pylori treatment failure and antibiotic resistance. Complete every dose.

Avoid Alcohol

Tinidazole causes a severe disulfiram-like reaction with alcohol, nausea, vomiting, flushing, palpitations, and severe discomfort. Avoid ALL alcohol during treatment and for at least 72 hours after completing the course.

Missed Dose

Take the missed dose as soon as remembered. If nearly time for the next dose, skip the missed one. Never double up.

Test of Cure

A breath test or stool antigen test should be performed at least 4 weeks after completing the kit to confirm successful H. pylori eradication; do not assume success without testing.

Common Side Effects

·       Metallic or bitter taste in the mouth (Clarithromycin and Tinidazole, very common, harmless)

·       Nausea or stomach discomfort (take with food to reduce)

·       Diarrhoea or loose stools

·       Headache

·       Dizziness (Tinidazole)

·       Abdominal cramps

Uncommon Side Effects

·       Oral thrush (Candida), antibiotic disruption of normal oral and gut flora

·       Skin rash or urticaria

·       Elevated liver enzymes

·       Dark or reddish-brown urine (Tinidazole metabolite, harmless)

·       Furry or discoloured tongue

Serious Side Effects, Seek Immediate Medical Attention

·       Clostridioides difficile colitis (severe antibiotic-associated diarrhoea; seek urgent care if diarrhoea becomes bloody, watery, or associated with fever and cramps)

·       Severe allergic reaction to Clarithromycin (anaphylaxis, angioedema; seek emergency care)

·       QT prolongation and risk of cardiac arrhythmia (Clarithromycin; avoid in patients with known QT prolongation or on QT-prolonging medicines)

·       Severe hepatotoxicity (rare; both Clarithromycin and Tinidazole can affect the liver)

·       Disulfiram-like reaction with alcohol (Tinidazole), severe nausea, vomiting, flushing, palpitations

·       Peripheral neuropathy with prolonged high-dose Tinidazole use (rare at standard H. pylori eradication doses)

·       ALCOHOL, ABSOLUTE PROHIBITION: Tinidazole causes a severe disulfiram-like reaction with alcohol. Do not drink ANY alcohol during the full course of Sure Kit and for at least 72 hours (3 days) after the last dose. This is non-negotiable; even small amounts of alcohol can cause severe nausea, vomiting, flushing, rapid heartbeat, and significant distress.

·       COMPLETE THE COURSE: Stopping early is the leading cause of H. pylori eradication failure and antibiotic resistance. The full 7–14 day course must be completed without exception.

·       CONFIRM ERADICATION: A test-of-cure (urea breath test or stool antigen test) performed at least 4 weeks after completing Sure Kit is essential; do not assume the bacteria have been eliminated without confirmatory testing.

·       QT PROLONGATION: Clarithromycin prolongs the QT interval; avoid in patients with known cardiac arrhythmia, QT prolongation, or those on other QT-prolonging medicines (amiodarone, haloperidol, chloroquine).

·       ANTIBIOTIC RESISTANCE: Clarithromycin resistance is rising globally; if Sure Kit fails, a second-line regimen (quadruple therapy with bismuth) is required, and the patient should be referred to a specialist.

·       MACROLIDE ALLERGY: If the patient has a documented macrolide allergy (erythromycin, azithromycin), Clarithromycin in Sure Kit must not be given; an alternative regimen without Clarithromycin is needed.

·       DARK URINE: Tinidazole produces a dark reddish-brown metabolite that discolours urine; this is harmless but should be explained in advance to prevent patient alarm.

Warfarin: Clarithromycin and Tinidazole both significantly enhance warfarin anticoagulant effect; monitor INR very closely during H. pylori treatment.

Statins (simvastatin, lovastatin, atorvastatin): Clarithromycin (CYP3A4 inhibitor) dramatically increases statin levels, serious myopathy risk. Consider pausing simvastatin or lovastatin for the duration of the course; atorvastatin requires monitoring.

Colchicine: Clarithromycin increases colchicine to potentially toxic levels; avoid combination or use with extreme caution.

Digoxin: Clarithromycin increases digoxin levels; monitor closely for digoxin toxicity.

Pimozide / Cisapride / Astemizole / Terfenadine: CONTRAINDICATED with Clarithromycin, risk of fatal QT prolongation and arrhythmia.

Ergotamine / Dihydroergotamine: CONTRAINDICATED with Clarithromycin, risk of ergotism (severe vasospasm).

QT-prolonging drugs (amiodarone, haloperidol, chloroquine, azithromycin): Additive QT prolongation with Clarithromycin; avoid.

Alcohol: CONTRAINDICATED with Tinidazole; disulfiram-like reaction.

Antifungals (fluconazole): Increases Clarithromycin levels.

Tacrolimus / Cyclosporine: Clarithromycin markedly increases immunosuppressant levels, serious toxicity risk.

Phenytoin / Carbamazepine: Clarithromycin may increase anticonvulsant levels; monitor for toxicity.

·       Store all components below 25°C in a cool, dry place.

·       Protect from moisture and direct sunlight.

·       Keep each medicine in its original packaging.

·       Keep out of reach of children.

·       Do not use after the expiry dates printed on each pack.

Sure Kit is available at Pharmily with a pharmacist recommendation following confirmed H. pylori diagnosis, or with a doctor's prescription. H. pylori testing before treatment is strongly recommended; empirical treatment without confirmed diagnosis is discouraged as a matter of antibiotic stewardship. Available at Pharmily.

Sure Kit (Lansoprazole + Clarithromycin + Tinidazole) is a Tinidazole-based triple therapy, an important alternative to Amoxicillin-based regimens (such as Pylotrip) for patients with penicillin allergy or in settings with higher Amoxicillin resistance. NOTE: This Sure Kit (H.

Confirm H. pylori diagnosis before dispensing; urea breath test or stool antigen test preferred. Biopsy-based diagnosis (CLO test or histology) is also acceptable. The ALCOHOL prohibition with Tinidazole is the most critical patient safety counselling point; document explicitly. Unlike Metronidazole (where the interaction is also present), Tinidazole's longer half-life means the prohibition extends 72 hours beyond the last dose. Macrolide allergy screening is mandatory; a documented allergy to Clarithromycin, Erythromycin, or Azithromycin requires an alternative regimen.

The Clarithromycin CYP3A4 interactions are extensive and clinically important; screen the full medication list for statins (especially simvastatin, lovastatin), warfarin, digoxin, colchicine, tacrolimus, and QT-prolonging drugs. Test-of-cure planning should be initiated at dispensing; communicate clearly to the patient and ensure follow-up is arranged with the prescriber or GP. 14-day courses are preferred over 7-day in the current antibiotic resistance climate; confirm duration with the prescribing clinician.

Q1: What is Sure Kit used for?

A: Sure Kit is an H. pylori eradication kit, a combination of three medicines taken together to eliminate Helicobacter pylori, the stomach bacterium that causes peptic ulcers, chronic gastritis, and persistent stomach pain. Successfully eliminating H. pylori heals ulcers and dramatically reduces their chance of returning.

Q2: Why does Sure Kit contain three different medicines?

A: H. pylori requires two antibiotics (Clarithromycin and Tinidazole) to attack it from different angles; using two reduces resistance and improves eradication rates. Lansoprazole reduces stomach acid, creating a better environment for the antibiotics to work and allowing the stomach lining to heal.

Q3: Why can't I drink alcohol with Sure Kit?

A: Tinidazole in Sure Kit causes a severe reaction with alcohol, producing nausea, vomiting, facial flushing, rapid heartbeat, and significant distress. You must avoid ALL alcohol during your full course and for at least 3 days (72 hours) after the last dose.

Q4: How long do I need to take Sure Kit for?

A: Typically 7–14 days, twice daily, morning and evening. Your doctor will specify the exact duration. Completing every dose of the full course is essential; stopping early means the bacteria may not be fully eliminated.

Q5: My urine has turned dark; should I be worried?

A: No. Tinidazole produces a harmless dark reddish-brown metabolite that discolours urine. This is normal and will clear once treatment is finished.