How to choose six antibacterial drugs for the eradication of Helicobacter pylori?

Once Helicobacter pylori infection is diagnosed, eradication treatment is usually advocated. Currently, relevant guidelines recommend that the eradication of Helicobacter pylori should use a quadruple combination of bismuth + proton pump inhibitors + two antibacterial drugs Program, the course of treatment is 10-14 days, antibacterial drugs are the key factors to eradicate Helicobacter pylori infection, bismuth and omeprazole and other proton pump inhibitors are used as an adjuvant to antibacterial drugs, such as prazoles By inhibiting the secretion of gastric acid, the pH in the stomach can be increased, and the drug stability of antibacterial drugs that are not resistant to gastric acid can be improved in the stomach, so as to prevent them from being damaged and ineffective by gastric acid.

Although there are many kinds of antibacterial drugs, but for the eradication of Helicobacter pylori, the guidelines only recommend six kinds, namely A Moxicillin, furazolidone, tetracycline and clarithromycin, levofloxacin and metronidazole, among these six antibacterial drugs, according to the different drug resistance of Helicobacter pylori to antibacterial drugs, there are two groups of low drug resistance and high drug resistance. The low drug resistance group includes amoxicillin, furazolidone and tetracycline, and the high drug resistance group includes levofloxacin, metronidazole and clarithromycin. When choosing antibacterial drugs, the two drugs in the quadruple regimen should include at least one variety of low drug resistance group, such as amoxicillin + clarithromycin, or two varieties of low drug resistance group, such as amoxicillin + clarithromycin. Xilin + furazolidone, amoxicillin + tetracycline, etc. Antibacterial drugs are recommended to be taken after meals when eradicating Helicobacter pylori infection.

Although there are three varieties in the low drug resistance group, because furazolidone and tetracycline are often difficult to obtain clinically, in fact the most commonly used one is amoxicillin, which belongs to the penicillin class Antibacterial drugs are the first-line species of choice for the eradication of Helicobacter pylori, with strong sensitivity and high safety, but a few patients may experience severe adverse reactions of anaphylactic shock when using penicillins. Therefore, amoxicillin cannot be selected for this group of people . Amoxicillin is a time-dependent antibacterial drug. It usually needs to be taken 3-4 times a day when treating other infections. For the eradication of Helicobacter pylori, the method of taking amoxicillin is different from the past. The dosage regimen is 1g each time, after meals.

Tetracycline and furazolidone are very sensitive to Helicobacter pylori, but there are many adverse reactions in the clinical use of these two types of drugs, tetracycline The liver and kidney toxicity of similar drugs, damage to the blood system, nervous system, and adverse effects on bones and teeth all limit its clinical application. Furazolidone belongs to nitrofuran antibiotics. Although it is very sensitive to Helicobacter pylori, this Drugs can cause irreversible peripheral neuritis, and serious skin reactions such as serum sickness-like urticaria have limited clinical application. At present, furazolidone is only recommended for the treatment of Helicobacter pylori infection that is difficult to eradicate, and the dose should be selected 2 times a day. Once, a low dose of 0.1g each time, take the medicine after meals

Clarithromycin belongs to the macrolide antibiotics, and it also has a certain killing effect on Helicobacter pylori. There are many dosage forms of clarithromycin, including ordinary tablets, capsules, granules, dispersible tablets, sustained-release tablets and sustained-release capsules, which are used to eradicate Helicobacter pylori. The use of sustained-release tablets and capsules should be avoided, because most of the sustained-release preparations It is released and absorbed in the small intestine, while Helicobacter pylori is a bacterium parasitic on the surface of the gastric mucosa. The local high concentration in the stomach is more conducive to sterilization, so it is more suitable to choose ordinary tablets.

Metronidazole is a nitroimidazole antibacterial drug, and it also has certain bactericidal activity against Helicobacter pylori, but the drug resistance rate Therefore, if metronidazole is used in the initial eradication treatment, and metronidazole is used again in the remedial plan after eradication failure, it is necessary to increase the frequency of medication, and a large dose of 1600mg per day should be used, that is, 4 times a day. 400 mg once, take after meals

Levofloxacin belongs to quinolone antibacterial drugs, which are widely used clinically and have a high drug resistance rate. Therefore, levofloxacin is generally not recommended for the first treatment of Helicobacter pylori eradication If it fails, remedial treatment can be used as appropriate. Levofloxacin can be used to eradicate Helicobacter pylori. It can be taken once a day, 500 mg each time, or 200 mg twice a day, after meals.