When dispensing medication at an outpatient pharmacy
It is not uncommon to encounter Helicobacter pylori patients coming to pick up their medicines
Many people will have such questions
Why do you prescribe so many medicines?
How should I take so many medicines?
Today, I will give you a detailed introduction
Pyloric screw "Jun"
What is Helicobacter pylori?
Helicobacter pylori is a gram-negative bacillus that is very harsh on the growth environment, and it is the only bacteria found that can live in the human stomach for a long time, and it has been determined that Helicobacter pylori infection is one of the risk factors for gastric cancer.
Hazards of Helicobacter pylori
Most of the infected patients have no symptoms and complications, but almost all of them have chronic active gastritis, and about 15%-20% of infected patients develop peptic ulcer, 5%-10% develop dyspepsia, and about 1% develop gastric malignancy.
Symptoms that may occur
Most infected people have no obvious symptoms, and the main symptoms are acid reflux, heartburn, stomach pain, bloating, and stubborn bad breath. It may also cause clinical manifestations of chronic gastritis, with nausea and vomiting, abdominal distension, abdominal pain, loss of appetite, belching and other symptoms of upper gastrointestinal tract receptivity, the course of the disease is slow, but it is easy to recur.
What are the modes of transmission?
Helicobacter pylori can be transmitted by the fecal-oral route (e.g., faecally contaminated water sources), oral-oral route (e.g., from parent to child transmission through saliva), and mother-to-child transmission (unclean breastfeeding, mouth-to-mouth feeding, chewing after feeding, kissing the infant's lips, or feeding using adult utensils).
What department to hang and what to do to check?
To see Helicobacter pylori, it is recommended to go to the gastroenterology department of a regular hospital for treatment, and the first choice is carbon-13 or carbon-14 urea breath test, which is non-invasive, painless, accurate, low-radiation, and the results can be obtained in about half an hour; It can also be detected by a rapid urease test performed by gastroscopy.
How is Helicobacter pylori treated?
Helicobacter pylori is very sensitive to antibiotics, and the use of an antimicrobial drug does not respond well to its treatment, and it is easy to develop resistance. The use of quadruple therapy (a combination of four drugs) can not only increase the stability of the antimicrobial, but also increase the cure rate of the bacterium
What is Quadruple Therapy?
Quadruple therapy is a combination of proton pump inhibitors + antibiotic A + antibiotic B + bismuth to eradicate H. pylori infection.
Proton pump inhibitors: inhibit the secretion of gastric acid and create a suitable environment for antibiotic sterilization.
Commonly used drugs include: esomeprazole 20 mg, rabeprazole 10 mg (or 20 mg), omeprazole 20 mg, lansoprazole 30 mg, pantoprazole 40 mg, ilaprazole 5 mg.
Choose one according to the actual situation, 2 times a day, and take it orally half an hour before meals.
Two antibiotics: kill Helicobacter pylori
Commonly used antibacterial drugs are: amoxicillin, clarithromycin, metronidazole, levofloxacin, furazolidone, tetracycline.
Antibiotic combination, dosage, and administration
(1) Amoxicillin 1000mg, 2 times/day + clarithromycin 500mg, 2 times/day;
(2) Amoxicillin 1000mg, 2 times/day + metronidazole 400mg, 3 times/day or 4 times/day;
(3) Amoxicillin 1000mg, 2 times/day + tetracycline 500mg, 3 times/day or 4 times/day;
(4) Amoxicillin 1000mg, 2 times/day + Furazolidone 100mg, 2 times/day;
(5) amoxicillin 1000mg, 2 times/day + levofloxacin 500mg, 1 time/day or 200mg, 2 times/day;
(6) tetracycline 500mg, 3 times/day or 4 times/day + furazolidone 100mg, 2 times/day;
(7) Tetracycline 500mg, 3 times/day or 4 times/day + metronidazole 400mg, 3 times/day or 4 times/day;
Choose one of the above antibiotic combinations and take it after meals.
Bismuth agent: has an auxiliary bactericidal effect.
Commonly used drugs include: colloidal pectin bismuth, colloidal bismuth tartrate, bismuth potassium citrate, etc
Oral administration 2 times a day, half an hour before meals.
It should be noted that:
Amoxicillin has a strong anti-Helicobacter pylori infection effect, is not easy to develop drug resistance, and has a low incidence of adverse reactions, so it is the antibiotic of choice for the eradication of Helicobacter pylori infection, but patients who are allergic to penicillin can replace amoxicillin with tetracycline or furazolidone with low drug resistance rate.
After using bismuth, there may be a peculiar smell (ammonia smell) in the mouth, and the tongue coating and stool may turn gray-black.
How long do I have to take the medicine?
The current course of treatment for quadruple therapy is 10 or 14 days. If it is less than 10 days, it may not be completely eradicated; If it exceeds 14 days, it will increase the risk of adverse reactions and drug resistance. Once treatment is initiated, it must be adhered to, and interrupting or taking medication irregularly can easily lead to treatment failure or "relapse", causing microbiota resistance.
When will I be re-examined?
Follow-up is recommended one month after the end of eradication therapy. Urea breath test is preferred for follow-up testing to determine if H. pylori infection is still present.
How to prevent and prevent?
Tips: The rate of H. pylori infection can be reduced by the following measures:
(1) Wash your hands before meals and after using the toilet, put an end to eating raw meat, and try to eat cooked food that has been heated at high temperature;
(2) Pay attention to oral hygiene, advocate brushing and rinsing after meals, and change toothbrushes regularly;
(3) If a member of the family is infected with Helicobacter pylori, the infected person should try to use his own utensils until he is completely cured;
(4) Advocate the separate meal system, the use of spoons and chopsticks, and pay attention to the disinfection of tableware;
(5) Children are susceptible to the population, use special tableware for children, and prevent parents from chewing food and feeding it to babies;
(6) Avoid smoking, drinking, and not eating spicy, cold and other irritating foods; Eat a balanced diet and chew slowly.
Reviewers: Yang Yuanrong, Chief Pharmacist, Department of Pharmacy, Jingzhou Central Hospital, Xiong Jianqun, Deputy Chief Pharmacist
Author: Liu Kaifei, Pharmacist-in-Charge, Department of Pharmacy, Jingzhou Central Hospital