Pharmacotherapy of Helicobacter pylori
Helicobacter pylori eradication protocols[edit | edit source]
The aim of the pharmacotherapy of Helicobacter pylori is to eradicate it and thus improve the healing of the mucosa.
First-line therapy[edit | edit source]
For this purpose, a "triple combination" of drugs is used as a first-line choice. This therapy consists of a proton pump inhibitor (most commonly omeprazole at a dose of 2 × 20 mg/day, but others can be used too at appropriate dosing: lansoprazole, pantoprazole, esomeprazole, rabeprazole) and two antibiotics: clarithromycin (2 × 500 mg/day), and amoxicillin (2 × 1000 mg/day). If the patient is allergic to amoxicillin and/or other penicillin-derived drugs (beta-lactams), they can be replaced with metronidazole or tinidazole (2 × 400-500 mg/day). This treatment should be taken daily for 14 days and leads to eradication in ca. 70% of cases.
Second-line therapy[edit | edit source]
If the patient is allergic to clarithromycin, or the first-line treatment has failed (possibly due to clarithromycin resistance, ca. 20% of cases), an alternative "quadruple therapy" treatment should be used instead (not common in the Czech Republic). This therapy consists of omeprazole (2 × 20 mg/day, or any other proton pump inhibitor), colloidal bismuth (4 × 120 mg/day), tetracycline (4 × 500 mg/day) or amoxicillin (2 × 1000 mg/day), and metronidazole (2–3 × 500 mg/day). This therapy should be administered daily for 14 days and leads to eradication in more than 90% of patients.
Sequential therapy[edit | edit source]
Sequential therapy can be used when patients have recurrent H. Pylori infections. It is a ten-day long therapy involving the administration of a proton pump inhibitor (omeprazole at 2 × 20 mg/day) and levofloxacin (2 × 500 mg/day) or amoxicillin (2 × 1000 mg/day) for the first five days followed by the administration of omeprazole (2 × 20 mg/day), clarithromycin (2 × 500 mg/day), and metronidazole (2 × 500 mg/day) for the next five days.
References[edit | edit source]
Literature[edit | edit source]
- VONDRÁČKOVÁ, Hana. Receptura magistraliter [přednáška k předmětu Farmakologie, obor Zubní lékařství, 1. LF UK]. Praha.
- PHARMINDEX brevíř
- ČEŠKA, Richard, et al. Interna. 2. vydání. Praha : Triton, 2015. 909 s. ISBN 978-80-7387-895-5.
- MUDr. TOMISLAV ŠVESTKA, CSC,. Infekce Helicobacter pylori. Medicína pro praxi [online]. 2011, no. 3, s. 123-126, dostupné také z <https://www.medicinapropraxi.cz/pdfs/med/2011/03/06.pdf>.
- Molina-Infante, J; Romano, M; Fernandez-Bermejo, M; Federico, A; Gravina, AG; Pozzati, L; Garcia-Abadia, E; Vinagre-Rodriguez, G; Martinez-Alcala, C; Hernandez-Alonso, M; Miranda, A; Iovene, MR; Pazos-Pacheco, C; Gisbert, JP (July 2013). "Optimized nonbismuth quadruple therapies cure most patients with Helicobacter pylori infection in populations with high rates of antibiotic resistance". Gastroenterology. 145 (1): 121–128.e1. doi:10.1053/j.gastro.2013.03.050
- Malfertheiner, P; Megraud, F; O'Morain, C; Bazzoli, F; El-Omar, E; Graham, D; Hunt, R; Rokkas, T; Vakil, N; Kuipers, EJ (June 2007). "Current concepts in the management of Helicobacter pylori infection: the Maastricht III Consensus Report". Gut. 56 (6): 772–81. doi:10.1136/gut.2006.101634