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After reading this article, a person without a medical education may not only understand what Helicobacter pylori infection is, but the main thing is why it should be treated, and how it should be treated in accordance with modern concepts. Therefore if a doctor just offers you a “drink antibiotic” to get rid of Helicobacter pylori, then after reading this article, you, of course, run away from a doctor like the plague, and you will look for real specialist. Helicobacter pylori infection treatment difficult, but first things first.
At first it seemed unbelievable that in the acidic environment of the stomach, which can dissolve even iron filings, can live and multiply any microorganism. Then it became proven. by the fact. This is a gentle, spiral-bound microorganism – Helicobacter pylori. At first they were considered an accidental find, then – harmless saprophytes. But then these germs became more and more occur in patients with abdominal pain, belching, heartburn and other symptoms of upper, or gastric dyspepsia.
But at times the importance of this pathogen has increased when a close relationship was found with the presence of Helicobacter pylori with the development of gastric ulcer and malignant neoplasms of this organ in carriers of helicobacter. Oncologists consider the presence of Helicobacter pylori infection brightly pronounced carcinogen level 1.
It is important that the presence of this infection is currently very just. There is a special urease breath test. This is very effective and non-invasive method, it only needs to be done “breathe into the tube.” Everyone can do this test and find out Is the person at risk.
But, unfortunately, “our people” do not attach importance to prevention, and often get on the operating table already with complications – for example, stomach ulcer. Therefore, if a person is older than 50-55 years, if he already has symptoms of dyspeptic disorders, and physician is “alert for oncology,” (for example, there is a loss body weight, appetite, the presence of symptoms of iron deficiency anemia), then you already need to perform a gastroendoscopy with a biopsy.
It is proved that the presence of a long-running Helicobacter pylori infection can cause not only a stomach ulcer and duodenum, as well as cancer of the stomach. Helicobacter pylori infection can cause iron deficiency anemia, drop platelets in the blood plasma, cause chronic vitamin deficiency B12, which is manifested by neurological disorders.
Therefore, the treatment of Helicobacter pylori infection is an important, though not simple. The very procedure for the destruction of this microorganism is called eradication, which is translated from Latin as “eradication”. it nonrandom term. Just like that, by assigning any one medicines, “accidentally” destroy Helicobacter pylori infection, for which the harsh conditions of gastric juice is the norm, is impossible. There are many eradication schemes that are all recognized, “work”, and apply in the presence of certain indications. But before go to medication, it is necessary to accurately determine the indications for treatment.
- Who is indicated for treatment?
- Overview of drugs for the treatment of Helicobacter pylori infection (Helicobacter pylori)
- Essential Drugs for Eradication
- IPP – proton pump inhibitors
- Omeprazole (Gastrozole, Omez, Orthanol, Ultop)
- Pantoprazole (Nolpase)
- Lansoprazole (Helicol, Ranzap, Lanzoptol, Lantsid, Epicurus)
- Rabeprazole (Bereta, Pariet, Zulbeks, Rabelok, Razo, Ultsernil, Hayrabesol)
- Esomeprazole (Nexium, Emanera)
- Antibacterial agents
- Clarithromycin (Klacid, Klabaks, Klabakt, Ekozitrin)
- Levofloxacin (Left, Remedi, Tavanic)
- Combination drugs: three in one
- Bismuth preparations
- De nol
- How to treat Helicobacter correctly?
- How to strengthen the treatment regimen?
Who is indicated for treatment?
In today’s world, countries with a high level of medicine, there is a preventive focus on treatment. It means, that it’s better not to allow any condition than to treat then the developed disease, spending a lot of money. Therefore in in case a person who does not have any complaints on their own decides to be examined for Helicobacter pylori infection and she confirmed that it is possible to conduct treatment with preventive goal to reduce the risk of serious illness afterwards.
If the patient already has any symptoms, then in In this case, the treatment is all the more indicated, and first of all, with conditions such as:
- the presence of severe dyspepsia symptoms, such as heartburn, nausea, bloating, and heaviness in the stomach after eating;
- dull, non-localized, wandering pains or discomfort in epigastrium;
- nausea and bitterness in the mouth;
- the presence of a diagnosed gastric ulcer and or duodenum against the background of identified Helicobacter pylori infections
- specific lymphoma, or a tumor associated with the mucosa the membrane of the stomach, the so-called MALT – lymphoma;
- Helicobacter pylori infection is known to increase the risk of developing erosive gastritis and peptic ulcer with prolonged use non-steroidal anti-inflammatory drugs such as aspirin, and especially indomethacin and diclofenac. Therefore, if Helicobacter pylori infection is proved and he is preparing receive non-steroidal anti-inflammatory drugs for a long time, for example, with a diagnosis of rheumatoid arthritis, then he also preventive treatment is needed;
- in the presence of proven intestinal metaplasia, or atrophy epithelium detected by gastroduodenoscopy;
- if the patient – the carrier of Helicobacter pylori infection has immediate relatives – parents, or brothers and sisters, whose stomach cancer was detected or there were deaths in the family from this diseases
- in the presence of iron deficiency anemia of unknown etiology, with the exclusion of other causes, as well as with idiopathic thrombocytopenic purpura;
- another indication for prescribing an eradication regimen is diagnosed with Menetrie disease, or hypertrophic gastritis. With this disease, the mucous membrane of the stomach increases, forms folds, cystic develops in it formations and various adenomas. Menetrie disease is known to considered optional (optional) precancerous condition.
Modern gastroenterology does not stand still, and constantly the best eradication schemes are selected. After all, this microorganism, like all other microbes guilty of the development of certain diseases, constantly improved, and resistance, that is Helicobacter resistance to antibiotics is gradually increasing. Therefore, the basis of this article will be the so-called “Maastricht 2015 Consensus. ”
According to this reputable meeting of gastroenterologists, the results of which are accepted for action in many countries of the world, in including in the Russian Federation, and recommended by the world Health Organization (WHO), timely treatment Helicobacter pylori infection, or eradication:
- reduces the risk of developing malignant neoplasms of the stomach almost 35%;
- already diagnosed precancerous diseases of the stomach cease progress;
- if gastroscopy revealed gastric atrophy, then such atrophy disappears, and the mucous membrane of the stomach is being restored;
Finally, timely eradication of Helicobacter pylori infection It is economically beneficial to both the patient and the doctor, since its cost extremely low compared to the cost of deployed treatment cases of ulcers or cancer of the stomach, the cause of which is this infection.
Overview of drugs for the treatment of Helicobacter pylori infection (Helicobacter pylori)
|Nomination||a place||Name of product||price|
|IPP – proton pump inhibitors||1||Omeprazole (Gastrozole, Omez, Orthanol, Ultop)||163 rub|
|2||Pantoprazole (Nolpase)||462 rub|
|3||Lansoprazole (Helicol, Ranzap, Lanzoptol, Lantsid, Epicurus)||334 rub|
|4||Rabeprazole (Bereta, Pariet, Zulbeks, Rabelok, Razo, Ultsernil, Hayrabesol)||2 125 rub.|
|5||Esomeprazole (Nexium, Emanera)||235 rub|
|Antibacterial agents||1||Clarithromycin (Klacid, Klabaks, Klabakt, Ekozitrin)||629 rub|
|5||Levofloxacin (Left, Remedi, Tavanic)||77 rub|
|Combination drugs: three in one||1||Pilobact||1 216 rub.|
|Bismuth preparations||1||De nol||887 rub|
|How to treat Helicobacter correctly|
|How to strengthen the treatment regimen|
Essential Drugs for Eradication
First, we list the main groups of drugs, which are used according to one or another scheme for eradication Helicobacter pylori infection. After reading this review, the patient is approximately will understand from what means the attending person will choose gastroenterologist. All of the following medicines represent preparations in tablets or capsules for treatment Helicobacter pylori infection do not apply injections, droppers or any other form of parenteral administration. Quite enough or conventional tablets, or coated tablets, or enteric capsules.
All listed drugs are registered in the territory Russian Federation, First, the list contains international generic name (INN) followed by a list of synonyms different drugs with the same active substance that produced by various companies. As a rule, the most expensive drug – it is original, that is, developed for the first time, the most reliable and using the purest substance. As known, being treated with the original medicine is always better for health, but it may be disadvantageous for a pocket. Of course there is high-quality generics, which, although not manufactured by the company, who released the original drug, but reliable reputable and good quality manufacturing companies medicinal substances.
The list also shows the minimum cost, as well as price range. Cost of funds assigned to eradication, given indicating the required amount of medication. List prices are relevant for pharmacies of various ownership forms. the territory of the Russian Federation for the fall of 2019.
Next, after the list of medicines, there will be it is directly told about various schemes therefore it is not necessary try to create yourself eradication schemes from drugs, which are given below, or apply any one drug. it gross error and nothing but self-medication.
IPP – proton pump inhibitors
Proton pump inhibitors reduce gastric acidity juice, and treat a symptom such as heartburn. There are several generations of these drugs, and the further down the list are located medicines of this group, the more modern and more effective.
The history of proton pump inhibitors began with omeprazole, which was first created in Sweden in 1979 under the name Losik. It began to be on sale since 1988 since during 9 years underwent various clinical trials, and immediately created a splash. With the introduction of this drug, the era has begun. agents that have been proven to control concentration acids of gastric juice. The use of antisecretory drugs in therapy for gastritis and peptic ulcer described below at the end finally led to a decrease in the number of surgical interventions for about ulcers, and made possible with early diagnosis conservative treatment of this serious illness. All the following medicines are used in certain eradication patterns.
It should be noted that the drug is the latest generation of PPIs, registered in Russia (Dexilant), not yet applicable in eradication therapy regimens. They treat erosive esophagitis, as well as gastroesophageal reflux disease. Therefore, do not consider what the drug itself will be best. therefore you must obey the instructions of your doctor, and if you get one pack of Dexilant for “self-made” eradication, then you just Spend 2000 rubles in vain.
Omeprazole (Gastrozole, Omez, Orthanol, Ultop)
Popularity Rating: 4.9
Omeprazole belongs to the first generation of proton inhibitors pumps, and it is successfully used in eradication therapy regimens, especially in their “budget” version. Omeprazole is available in 20 mg capsules, its effect is to reduce activity hydrogen-potassium ATPase – an enzyme involved in hydrochloric acid synthesis. As a result, the acidity of the gastric juice decreases.
Omeprazole acts quite quickly, and the maximum effect observed after 2 hours. The effect of the drug is gradually reduced, but even a day after taking a single dose, hydrochloric acid does not reaches 50% of its normal concentration, that is, it occurs reliable inhibition of half secretion. Omeprazole usually taken once a day, but in eradication schemes – twice a day, and the maximum effect in connection with the accumulation of the drug observed somewhere after 4-5 days. The drug is fully transformed in the liver with the participation of the cytochrome system, and excreted by the kidneys.
This drug is contraindicated in children, pregnant women and during breastfeeding, used with caution in hepatic and renal failure. Of the side effects most often urticaria occurs, sometimes diarrhea or constipation. Also no more often than in 1% of cases there may be abdominal pain, flatulence, episodes nausea. All other side effects occur very rarely, for example, joint pain, dry mouth, or decreased white blood cells in the peripheral blood.
Omeprazole should be used according to the scheme that it will offer gastroenterologist, but usually it is taken twice a day at a dose of 20 mg for one or two weeks, and always in combination with other drugs. Omeprazole alone, as well as any other proton pump inhibitor, even the most modern, does not can cope with Helicobacter pylori infection. Important what to take Omeprazole is possible with food, it does not affect the quality treatment.
The most famous drug from this group is Omez, which manufactured by the Indian laboratory Dr. Reddis. Cost of one packs of 30 capsules of omeprazole 20 mg each will cost around from 130 to 167 rubles. This is an inexpensive drug.
Popularity Rating: 4.8
Nolpase is a second-generation drug, pantoprazole. IN its tablet contains 22 mg, and it acts on the same the enzyme is hydrogen-potassium ATPase. Pantoprazole just as fast absorbed, and eating does not affect the quality of treatment. Same, like omeprazole, it is transformed in the liver and excreted through the kidneys. Unlike omeprazole, it can be used in patients with chronic renal failure, and even in those who are on hemodialysis. Pantoprazole can also be used in patients with cirrhosis, which is rare.
The medicine is available in tablets that dissolve in intestines, and is used in eradication schemes in combination with two antibiotics. As with omeprazole, contraindications include pregnancy, lactation and childhood under 18 years, due to the small amount of accumulated data.
Of the adverse reactions, diarrhea and headache are most common. pain that develops no more often than in 1% of patients. To others side effects include sleep disturbances, bloating and dry mouth, flatulence and constipation, as well as increased concentration hepatic transaminases. Skin rash may occur. In that case, if Nolpazu or other pantoprazole analogues are received by a patient with HIV infection, against the background of atazanavir, it is necessary to correct this treatment. For the eradication regimen, the drug is used in the same way as Omeprazole, one tablet 40 mg 2 times a day, the course of treatment is also from 1 to 2 weeks.
The Nolpazu company Krka releases. One pack of the drug calculated for two weeks of treatment according to eradication regimens, i.e. 28 tablets of 40 mg each, can be purchased in pharmacies from 370 to 430 rubles. Indian drug Panum, which is produced by the company Unic, can be purchased even cheaper – at a price of 230 to 417 rubles. in the same dose.
Lansoprazole (Helicol, Ranzap, Lanzoptol, Lantsid, Epicurus)
Popularity Rating: 4.7
Third-generation proton pump inhibitors such as Epicurus and Lantsid, also work with potassium-sodium ATPase at the last stage of formation of hydrochloric acid. As a result, decreases as general, basal, and stimulated secretion of gastric juice. As with omeprazole, the effect develops gradually, and reaches a maximum on day 4 of admission. The drug also binds to plasma proteins by 98%, when passing through the liver, he transformed and excreted by the kidneys.
As in the previous case, the tool is used to eradication therapy. Do not use for pregnant women nursing mothers, as well as people with a manifestation of hepatic or renal failure. Therefore, in the case of such a pathology Nolpaza will be more profitable. Side effects include headache, dizziness, drowsiness, diarrhea, skin allergic reactions, and also rhinitis and pharyngitis.
A feature of lansoprazole is the need to apply drug in the morning on an empty stomach. In case of eradication, you must take 30 mg medicine twice daily for up to 2 weeks, a in accordance with the recommendations of the gastroenterologist.
The cost of the domestic drug Epicurus, just in this dosage, in the amount of 14 pieces, that is, for one week of eradication, is from 370 to 580 rubles. Accordingly, for A full-fledged scheme requires two such packages. That is, you need focus somewhere on 1000 rubles. Indian drug Lantsid will cost much cheaper. One pack of indian lansoprazole – in a dosage of 30 mg No. 30, that is, it is enough for a full two-week eradication scheme. At the same time, its cost ranges from 330 to 415 rubles. As a result, the drug will cost twice cheaper.
Rabeprazole (Bereta, Pariet, Zulbeks, Rabelok, Razo, Ultsernil, Hayrabesol)
Popularity Rating: 4.6
4th generation proton pump inhibitors or blockers are known, perhaps the most expensive drug of this entire PPI group. it Soars, the original rabeprazole. It applies, of course, not only for the treatment of Helicobacter pylori infection, but also for ulcerative diseases in the acute stage, with erosive gastritis, with syndrome Zollinger-Ellison, and in other cases. He shoots very well heartburn and pain, and considered by many to be the most effective and safest of all IPPs.
It is used in the eradication scheme of 20 mg 2 times a day, according the scheme prescribed by the gastroenterologist, and always with prescribing appropriate antibiotics, which will be discussed below. It is important that the eradication scheme using Pariet, shorter than in other cases, and is only 7 days, but it still makes her the most expensive. How much will it cost eradication of Helicobacter pylori infection?
Standard pack containing tablets needed concentration of 14 pieces for this circuit will cost from 1950 and up to 2400 rubles. This drug is manufactured by Bush. Pharmaceuticals, and can be made in Japan, Switzerland, Belgium under the patronage of Janssen Cilag, i.e. Johnson &Johnson, Россия. Such international cooperation is not uncommon in the pharmaceutical industry.
Pariet is used in whole tablets at any time of the day and regardless of the meal, which is very convenient. As in previous cases, the drug is contraindicated in pregnancy and breastfeeding, also in childhood, with hypersensitivity to the active substance rabeprazole, and with caution – with severe renal failure. Side effects on pariet are mild, transient, and pariet usually tolerated very well without any disabilities organism. In the same case, if such effects occur, then not more often than in one case per 1000 people taking Pariet. it really very good tolerance, the drug justifies its price. If any violations occurred then this headache, stool disorders, dry mouth and constipation. Sure, if health costs are considered excessive, then you can choose and cheaper rabeprazole. So, a medicine called Razo Indian production will cost only from 320 to 450 rubles., with in this pack there will be not 14 tablets, but thirty.
Esomeprazole (Nexium, Emanera)
Popularity Rating: 4.5
Nexium is the fifth generation of proton pump inhibitors, or esomeprazole. It is applied in the same way as in previous cases for eradication schemes, at a dose of 20 mg 2 times a day for 1 week. Two-pack packaging of this medicine eradication, (i.e. 28 tablets per pack) will cost from 214 to 250 rubles., The drug is manufactured by Astrazeneca in Sweden. There are other analogues, for example, Emanera from Slovenia, which approximately in the same price range.
The drug acts quickly and for a long time. With daily intake the maximum development of the effect is observed on the fifth day, it is proved that even after stimulation with pentagastrin, gastric acidity juice is reduced by 90%. The effectiveness of this drug is good shows its purpose in peptic ulcer disease. After no more drugs required (enveloping) for the subsequent healing of ulcers, usually Nexium copes well on its own.
Also, this tool is effective for bleeding from peptic. This medicine is indicated for long-term use of NSAIDs. It significantly reduces the risk of stomach ulcers. Contraindications and side effects of this drug are approximately those same as with previous medicines, but from side of the effects of headache and discomfort in the stomach.
We move on to the second component of eradication therapy regimens, which is no less important than proton pump inhibitors. Decline gastric secretion allows Helicobacter to “knock out” pylori soil, dramatically changing its conditions of existence, creating her discomfort. As for antibacterial drugs, it is they directly perniciously affect various life forms Helicobacter pylori. There are a limited number of antibacterial funds from various groups that have been successfully tested international community of gastroenterologists for treatment Helicobacter pylori infection. These are clarithromycin antibiotics and amoxicillin, metronidazole, ancient, but quite effective the tetracycline antibiotic, which also found its use, as well a drug from the group of fluoroquinolones – levofloxacin. Consider briefly these medicines for modern regimens and eradication protocols.
Clarithromycin (Klacid, Klabaks, Klabakt, Ekozitrin)
Popularity Rating: 4.9
Clarithromycin is a macrolide antibiotic. His spectrum the application is extremely wide, we will not list it effectiveness in relation to certain microorganisms, we indicate just that Helicobacter pylori is highly sensitive to clarithromycin. However, at present her sensitivity gradually decreases, and treatment with clarithromycin should be carried out taking into account the patient’s area of residence. Are available regions in which Helicobacter pylori predominantly occurs infection with high resistance to clarithromycin, and then from the very First you need to use other schemes. And there are regions in which, According to epidemiological data, Helicobacter pylori is sensitive to Clarithromycin. In the case of high sensitivity, almost 85-90 % percent of patients will be successfully cured.
Clarithromycin is used for a week, twice a day. The usual dosage is 500 mg each. One of the most effective and highly purified preparations – this is the Italian Klacid. A drug contraindicated for use with ergot alkaloids for treatment of migraine, in pregnant and lactating women, children under 3 years. At patients with serious impaired liver function must be observed caution. Klacid, packaged in an amount of 14 tablets of 500 mg, just for the eradication therapy regimen, will cost from 650 to 850 rubles., A similar domestic drug Ekositrin, manufactured the company ABBA-Rus, will cost from 370 to 420 rubles.
Perhaps the cheapest can be considered Claritrosin, domestic synthesis company, but there is a catch. Pack of 10 tablets will cost from 230 to 300 rubles., but then you have to buy another pack that find the missing four tablets for completion of two days of the scheme. As a result, you will spend approximately as much money as the case of quality Italian Klacida.
Popularity Rating: 4.8
Amoxicillin is a semi-synthetic penicillin that is very quickly absorbed into the bloodstream, and excreted by the kidneys. Amoxicillin in eradication therapy regimens are prescribed in large dosages: 1000 mg, i.e. 1 g twice daily. Treatment lasts a week then there is a course just need 14 g of amoxicillin.
Perhaps the best choice is Flemoxin Solutab, which is produced just at a dosage of 1000 mg per soluble dispersible tablets in the package of these tablets 20 pieces, that is, 6 pieces will still remain. The cost of this drug is from 370 to 450 rubles., In excellent European quality. Lets him out Astellas company, the Netherlands. The second option is Amoxicillin Sandoz, which is produced in Austria. Its quality is no worse and the cost is much lower, from 150 to 175 rubles. Same dosage the most. The only drawback is the packaging of 12 tablets, i.e. have to look for two more additional pills, or buy again, as with Claritrosin, a new package, so it is better to opt for Flemoxin.
Flemoxin is contraindicated in case of sensitivity to semisynthetic penicillins, with great care it is necessary administered to patients diagnosed with lymphocytic leukemia, and the presence of chronic renal failure. Tool can used during pregnancy and lactation, but other drugs, included in the eradication scheme, during pregnancy can not be used. Therefore, it is better to treat Helicobacter pylori infection in women a different period of life. Also, the drug can cause side effects, but usually it is well tolerated. Eating does not affect treatment, one tablet is dissolved in a glass of water and drunk twice in day.
Popularity Rating: 4.7
Good old inexpensive tetracycline – broad antibiotic spectrum of action, and although rarely, it is used in special schemes eradication. It is contraindicated in case of renal failure, with a significant decrease in the number of white blood cells during pregnancy and breastfeeding, with caution appoint him with severe impaired liver function.
Tetracycline, which, perhaps, is almost all produced all in the Russian Federation, cannot adapt and convenient to pack for eradication schemes. It should be applied in high dosage, 500 mg 4 times a day, i.e. 2 g daily for 10 days. Thus, the total tetracycline per course will be 20 g. It is produced in tablets 100 mg, in a package of 20 tablets. Therefore, the course of treatment 10 packs of the drug are needed, and 20 need to be swallowed daily pills, and take it often. In the morning and at lunch, in the evening and at night – five tablets each time. Perhaps this is the most inconvenient option medicines that may occur in an eradication regimen. With considering what it is produced either in Belarus or Tyumen chemical factory, then about European quality and not talk have to.
Popularity Rating: 4.6
Metronidazole to eradicate Helicobacter pylori infection extensively applied the same way as clarithromycin, 500 mg 2 times a day during the week. Strictly speaking, it is not an antibiotic, and affects microorganisms with its nitro group containing nitrogen. So, metronidazole is released by the Takeda company, and it costs very cheaply, one pack of 20 tablets is enough for a course of eradication, and will cost it is not more expensive than 80 rubles.
While taking metronidazole, special caution. Categorically during treatment with metronidazole do not drink alcohol, as it may cause antabuse-like (or teturam-like) reaction. She is associated with incomplete oxidation of alcohol and accumulation of acetic in the blood aldehyde. This leads to difficulty in breathing, redness of the face, toxic effects on the liver with co-administration of alcohol on treatment with metronidazole.
It is contraindicated in case of leukopenia, with epilepsy and liver failure, in the first trimester pregnancy and breastfeeding. With the use of metronidazole there may be a metallic taste and dry mouth, diarrhea, dizziness, joint pain. In the event that the circuit eradication together involves taking amoxicillin, and metronidazole, the patient must be over 18 years old. On the while taking metronidazole, urine may turn reddish or brown, this is temporary and not worth it to get scared.
Levofloxacin (Left, Remedi, Tavanic)
Popularity Rating: 4.5
Finally, fluoroquinolone is used in eradication regimens. levofloxacin, one of the best representatives is considered a drug Tavanic. It is a broad spectrum antibacterial, which disrupts the DNA synthesis of microorganisms. Levofloxacin effective, especially with infection resistance to clarithromycin. Levofloxacin is prescribed at 500 mg 2 times a day, also during weeks or 10 days, by decision of the gastroenterologist.
Packaging Tavanic, designed for 5 days (10 tablets) in the scheme eradication, will cost from 670 to 900 rubles, and a full treatment – 1500-2000 rubles. Produced by the Tavanic company Sanofi from France. The cheapest counterpart may be the Glevo Indian company Genmark. One such pack of 25 tablets of 500 mg, which is enough for scheme will cost no more than 210 rubles.
In the appointment of Tavanic and Glevo should take into account such contraindications, such as myasthenia gravis, epilepsy, under 18 years of age and fluoroquinolone intolerance, pregnancy and the period of chest feeding. Very careful if needed predisposition to seizures, impaired renal function.
Combination drugs: three in one
Popularity Rating: 4.9
Popularity Rating: 4.8
In fairness, you need to name a combination drug, which is called Pilobact. It was created by enterprising Indians, company San Pharmaceutical. It immediately includes clarithromycin, omeprazole and tinidazole. There is also Pilobact-AM (clarithromycin, omeprazole and amoxicillin). So finished eradication scheme in one bottle. Apply this drug necessary for 7 days, the product consists of tablets and capsules. Capsules and tablets are labeled “morning” and “evening” separate color red and blue.
Such a drug costs about 1100 rubles. per pack tablets and capsules, just designed for a course of therapy. However, all three substances will be of Indian quality, although they are not bad. But if a person can spend as much on his treatment as if necessary, then the gastroenterologist will prescribe separately high quality antibiotics and proton pump blockers.
Finally, the last group of drugs that are used to eradication are bismuth compounds. Bismuth is an element periodic table, a metal that exhibits a number of amazing non-metallic properties. In acidic conditions of the stomach means containing bismuth, cover it with a protective film. Under this film the ulcer is well scarred, if any, and the mucosa is protected from harmful factors. Under the bismuth layer, the amount of mucus increases pepsin production decreases. Bismuth itself has an antimicrobial activity deep inside the mucus layer where the drugs from the blood can get bad. It is important that bismuth preparations if they are used in isolation, inhibit the activity of the microbe, but at the same time do not change the properties of gastric juice, and do not affect digestion. However, taking bismuth preparations can stain black feces. Colour.
These drugs are in reserve. They are prescribed if Helicobacter pylori the infection is very resistant to clarithromycin. Bismuth can destroy its various forms, both coccal and vegetative. we we will not list a large number of bismuth preparations, I let’s just say that they apply:
bismuth subnitrate or bismofalk;
complex cheap “ancient” drugs Vikalin and Vikair, which are produced in Russia. These are cheap medicines, a package of 20 tablets does not exceed the cost of 170 rubles, but they usually rude and poorly tolerated by many;
Popularity Rating: 4.9
A classic bismuth drug is colloidal subcitrate. bismuth in combination with potassium. It is sold under a well-known trade brand name De-nol, it is produced in Russia under the control of the company Astellas. This drug is also known as Escape.
For adults, De-nol is prescribed one tablet four times a day before meals. day and night. Other schemes are possible. No drugs take more than 2 months, but eradication lasts much shorter. The cost of the drug depends on the dosage, but the average packaging price of 32 tablets of 120 mg usually does not exceed 300 rubles;
in international recommendations you can also find subsalicylate bismuth, a metal compound with salicylic acid. This connection has a pronounced activity against Helicobacter pylori, but in the Russian Federation it is rarely used.
The term for taking bismuth compounds in eradication schemes is determined a doctor. Bismuth can not be taken during pregnancy and during breastfeeding, and you can not use it for too long, as it builds up in the central nervous system with gradual development of symptoms of encephalopathy.
How to treat Helicobacter correctly?
Now you know what medicines you need “etch” Helicobacter pylori infection from the body. Left choose a regimen. If you know that in this region of the country revealed the level of resistance of microbes to clarithromycin more 15%, then you have to apply alternative eradication schemes. Microbes also have resistance to metronidazole, and sometimes double resistance. But this, of course, of complexity and subtlety, doctor’s care.
So, there are several lines of treatment, and the first of them is universal. This line includes one of the blockers. proton pump, clarithromycin, amoxicillin or metronidazole. The standard duration of treatment is a week, but if it is increased to 2 weeks, then its effectiveness increases.
The next line also includes a proton pump inhibitor, metronidazole and tetracycline, but then the drug is also added bismuth in a dose of 120 mg 4 times a day. Such a four-component circuit (quadcircuit) lasts for 10 days. As it was said above, bismuth salts are prescribed if Helicobacter pylori infection resistance is quite high, that is why clarithromycin is not included here.
Here is an alternative protocol called “sequential therapy.” At the beginning, the patient for 5 days takes a proton pump inhibitor such as omeprazole and amoxicillin, and then for 5 days the first regimen continues: omeprazole continues to be administered, and clarithromycin is added and metronidazole with the abolition of amoxicillin. If the region of residence characterized by a high degree of resistance to clarithromycin, then levofloxacin is added to the eradication regimen instead.
Gastroenterologists and epidemiologists continued to rack their brains: how destroy such a small but so persistent Helicobacter pylori. Further, the so-called concomitant therapy was developed, and then the combination of two types: sequential and concomitant. IN the first case, the patient is prescribed a proton pump inhibitor, clarithromycin, amoxicillin and metronidazole for 10 days.
In the case of combining sequential and concomitant therapy in during the week, the patient takes a proton pump inhibitor and amoxicillin and then add metronidazole and clarithromycin with certain subtleties. This is a pretty high-performance tactic, up to 99% of the cure, with Helicobacter strains being destroyed even with double resistance.
How to strengthen the treatment regimen?
Continuing to fight Helicobacter pylori infection, they use and other medications. There are schemes using the antibiotic rifabutin (2500 rubles) and furazolidone. Is applied two-component therapy in high doses, and other regimens.
In addition to bismuth preparations, it is indicated in complex cases of use gastroprotector rebapimide (Rebagit). Its inclusion in schemes eradication can increase the effectiveness of treatment by 12%. Also increases the effectiveness of treatment by adding probiotics, bifidobacteria and lactobacilli.
It is very important to use only internationally accepted protocols. treatments, internationally approved dosages, and also important use only original drugs. Of course, generics, like would be effective, but the range of this efficiency is very large – from decent to complete falsification. Unfortunately, this is not about simultaneous pharmaceutical, therapeutic and biological equivalence with the original drug. Only compared “bioequivalence”. Therefore, in the event that the patient does not have opportunities to get really working drugs, and forced to limit only to the cheapest generics, then as a result, Helicobacter pylori infection will not be destroyed. The microorganism, in the end, will be trained in this patient resist weak and low-quality drugs acquiring additional resistance.
In conclusion, it should be cautioned that, despite the full treatment, you can get Helicobacter pylori infection again. TO unfortunately, the present vaccine against Helicobacter pylori. And existing and widely advertised food additives in the form of Helinorm containing “special lactobacilli “do not have a proven effectiveness. Helinorm produced under the patronage of Nizhpharm, but is a common food additive. However, this does not prevent the manufacturer from packing 28 ask for capsules from 1400 to 1900 rubles. This drug is not included in any one eradication scheme, and its name is practically not found in modern reviews dedicated to the treatment of this infection.
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