Pharmacotherapy of Helicobacter pylori

Helicobacter pylori eradication protocols

The aim of the pharmacotherapy of Helicobacter pylori is to eradicate it and thus improve the healing of the mucosa.

First-line therapy

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

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

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

Literature

• 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>.

External links

Infekce Helicobacter pylori – doporučený postup (in Czech)

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