Author: gcplive
Source: Center for Drug Evaluation
< span>H. pylori (H. pylori) is a microaerophilic gram-negative bacillus that lives in various regions of the stomach and duodenum. H. pylori infection can cause mild chronic inflammation of the gastric mucosa, gastric and duodenal ulcers, and gastric cancer.
I. H.pylori eradication program
Currently, the domestic recommended “bismuth agent IV” Combination therapy “eradication program: PPI + bismuth + 2 kinds of antibacterial drugs.
Second, “Bismuth quadruple therapy” eradication principle and deficiency
1. Principle of eradication
Inhibition by PPIs Gastric acid secretion, increase the pH value of gastric juice, increase the stability of antibiotics in gastric juice, reduce the MIC of antibiotics, and improve the efficacy of antibiotics.
2.Deficiencies< /span>
There are six recommended antibacterial drugs: amoxicillin, tetracycline, furazolidone, clarithromycin, metronidazole, and levofloxacin.
Three drugs (clarithromycin, metronidazole, levofloxacin) had a high resistance rate (>20%).
The resistance rate of three drugs (amoxicillin, tetracycline, furazolidone) was low (<5%).
Two drugs (tetracycline, furazolidone) have serious side effects.
Tetracycline can cause esophageal damage and photosensitivity.
Furazolidone can cause irreversible neuritis and severe skin reactions.
Third, “high-dose dual therapy”, the expert consensus is here!
Expert Consensus on Proton Pump Inhibitor Examination Rules (2022) formulated by the Pharmacy Management Professional Committee of Chongqing Hospital Association >See the table below for recommendations.
1. Fundamentals< /span>
Increasing the frequency of administration of proton pump inhibitors can further increase gastric pH and promote the reproduction of Helicobacter pylori. Amoxicillin is a bactericidal drug in the reproductive period and has a stronger bactericidal effect.
Amoxicillin is a time-dependent antibacterial drug. Increasing the frequency of amoxicillin administration can improve its antibacterial effect.
2. Adverse reactions
and bismuth four Compared with combination therapy, high-dose combination therapy has a lower incidence of adverse reactions and better patient compliance.
The common adverse reactions are dizziness, nausea, loss of appetite, fatigue, diarrhea, etc.
3. Can bismuth potassium citrate be added?
No.
In the acid environment of the stomach, most of the bismuth agents are converted into insoluble bismuth trioxide, bismuth hydroxide, etc., which are rarely absorbed.
Increase the dose and frequency of proton pump inhibitors, and increase gastric pH, which can promote the absorption of bismuth and increase the risk of bismuth poisoning.
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