With the deepening of the understanding of the harm of Helicobacter pylori, more and more people are receiving Helicobacter pylori eradication treatment (please see the previous article Helicobacter pylori, why should we kill it?). ）。 This article mainly introduces some knowledge about Helicobacter pylori sterilization (for adults).
The rate of drug resistance in Helicobacter pylori is increasing worldwide, with some antibiotics having a higher rate of resistance. After the failure of the first eradication treatment, there are not many options for remedial treatment, and Helicobacter pylori may have developed resistance, making it difficult to eradicate it again. Therefore, Helicobacter pylori should be removed as much as possible at one time. It can be said that for Helicobacter pylori, the first battle is a decisive battle. At present, the eradication scheme recommended by the Fifth National Consensus Report on the Treatment of Helicobacter pylori infection (hereinafter referred to as the Consensus) in China is a quadrant regimen containing bismuth agents.
Drug composition of the Helicobacter pylori sterilization regimen
The consensus-recommended quadrant regimen for the eradication of Helicobacter pylori includes proton pump inhibitors, bismuth agents, and two antibiotics for a total of 4 drugs.
Proton pump inhibitors include esomeprazole (20 mg), rabeprazole (10 mg or 20 mg), omeprazole (20 mg), lansoprazole (30 mg), pantoprazole (40 mg), eprazole (5 mg), choose one of the above drugs, twice daily, orally for half an hour before meals.
Bismuth usually refers to bismuth citrate potassium, the standard dose is 220 mg twice a day, also taken orally half an hour before meals. Colloidal pectin bismuth can also be chosen, but the standard dose of the drug has not been determined, and according to previous studies, 200 mg can be selected twice a day or 150 mg three times a day.
There are currently 6 antibiotics that can be selected in the quad regimen determined by consensus. These include amoxicillin, clarithromycin, metronidazole, tetracycline, furazolidone and levofloxacin. If there is no history of penicillin allergy and a negative skin test, amoxicillin plus another antibiotic is preferred, as amoxicillin has few side effects and low resistance rates without allergies. Amoxicillin can be combined with any of the other 5 antibiotics, but levofloxacin and furazolidone are not recommended for the first eradication regimen. If there is a history of penicillin allergy or a positive penicillin skin test, amoxicillin cannot be selected, and two of the other 5 antibiotics can be selected, such as tetracycline plus metronidazole and clarithromycin plus metronidazole. Among these 6 drugs, the resistance rate of amoxicillin, tetracycline and furazolidone was relatively low, and the resistance rate of clarithromycin, metronidazole and levofloxacin was higher. The choice of specific antibiotics needs to consider factors such as antibiotic resistance rates, efficacy, personal drug use history, cost, adverse reactions, and availability of the drug.
Some possible alternative drugs
Funorasine fumarate (Walker) is a new type of drug that inhibits stomach acid, its acid inhibition effect is more powerful than that of proton pump inhibitors, can be used to replace proton pump inhibitors, and some studies believe that it can improve the eradication rate. The general dosage is 20 mg twice a day.
Some scholars have tried to use other antibiotics as a choice for Helicobacter pylori sterilization, such as amoxicillin clavulanate potassium, cephalosporin antibiotics, minocycline and rifabutin, etc., these drugs have certain application prospects, if necessary, they can be considered, but they are not currently recommended by consensus.
Precautions during medication
The standard course of quadruple therapy is 10 to 14 days. Continuous medication should be ensured as much as possible to complete the course of treatment, avoid missing and taking less. There may be some adverse reactions in the process of taking the drug, such as dizziness, headache, nausea, vomiting, abdominal discomfort, fatigue, increased stool or diarrhea, bitter mouth, etc., these adverse reactions can be tolerated in most cases, do not affect the continuation of medication, a small number of people have more obvious symptoms and have to stop the drug. During oral antibiotics, pay close attention to whether there are allergic reactions such as rashes, especially serious reactions such as lip edema and dyspnea, and if allergic reactions occur, the drug should be stopped immediately and a doctor should be seen. Oral bismuth can cause melaena, which is a normal reaction to taking the drug, does not affect the continuation of the drug, if there is a high degree of suspicion that black is caused by gastrointestinal bleeding can check fecal occult blood. During the medication, you should eat a light diet, avoid spicy and irritating foods, avoid drinking alcohol and ingest seafood. Probiotics can be added during the medication (which needs to be staggered with antibiotics for two hours) to help reduce gastrointestinal adverse reactions and possibly even increase eradication rates.
What happens after the first eradication treatment fails?
After the first treatment fails, a remedial regimen can be selected. The main adjustment of the remedy is antibiotics. If clarithromycin or levofloxacin is included in the initial regimen, then reuse should be avoided in the remediation regimen. Metronidazole resistance is also relatively high, and the dose should be increased if used again. If repeated eradication therapy fails, a drug susceptibility test should be performed in a conditional unit and antibiotics should be selected under the guidance of susceptibility results.
Remedial therapy should be started at intervals of more than 6 months unless necessary after initial treatment failure. Because the bacteria that have survived after the initial treatment are in a state of self-protection, the body is spherical, at this time Helicobacter pylori is not sensitive to antibiotics, and sterilization may fail again. Therefore, it is necessary to wait for the bacteria to return to their normal form before starting remedial treatment.
Follow-up after eradication
After taking the quadruple drug for a full course of treatment, the blowing test should be rechecked one month after stopping the drug to determine whether the eradication is successful (for precautions for blowing test, please see the previous article Suspected Ofs pylori infection, why can't the blowing test find out?). ）。 After eradication, attention should be paid to dietary hygiene to avoid reinfection. The rate of re-infection after eradication of Helicobacter pylori is not high, and domestic studies have shown that the rate of re-infection is about 1.5% / human year. Helicobacter pylori may be transmitted among family members, and other family members should also be considered to detect and eradicate Helicobacter pylori.