Treatment Of Helicobacter Pylori - Treatment Regimen, List Of Drugs

2024 Author: Josephine Shorter | [email protected]. Last modified: 2024-01-15 09:49

Treatment of Helicobacter pylori: a detailed treatment regimen

According to medical statistics, 50 to 70% of the world's population is infected with the pathogenic microorganism Helicobacter pylori. The bacterium does not always cause serious changes in the body, some of its carriers will never know that they are carriers of heliobacteriosis.

Content:

• Should Helicobacter pylori be treated?
• Which doctor treats heliobacteriosis?
• Diagnostic minimum for suspected heliobacteriosis
• Indications and basic principles of therapy
• Effective methods of treatment for Helicobacter pylori
• Antibiotics - # 1 remedy for the treatment of helicobacter pylori
• Helicobacter pylori chemotherapy with antibacterial drugs
• Possible complications from antibiotic treatment
• How to get rid of helicobacter pylori without including antibiotics in the eradication regimen?

Should Helicobacter pylori be treated?

It is irrational to prescribe antibacterial treatment to every second person, although the consequences of infection with helicobacter pylori can lead to serious complications. First of all, it is gastritis and peptic ulcer that affects the stomach and duodenum. Untreated pathologies of the digestive system with reduced immunity are transformed into malignant formations, can cause bleeding, perforation of the stomach wall, sepsis and death.

When to start therapy for heliobacteriosis, what to take, how long the course of treatment lasts - all these questions will be answered by a qualified specialist of a medical institution.

Diagnostic minimum for suspected heliobacteriosis

The doctor prescribes a diagnostic examination to determine the amount of helicobacter pylori in the patient's body, how its presence affected the mucous membrane of the digestive tract, and also to find out which treatment to choose in a particular case. Diagnostic methods for heliobacteriosis are determined on an individual basis. Diagnostic examination can be carried out both in a public and private laboratory.

To assess the condition of the gastric mucosa, the gastroenterologist will definitely prescribe an endoscopic examination:

• FGS (fibrogastroscopy);
• FGDS (fibrogastroesophagoduodenoscopy).

Gastric endoscopy reveals ulcers, edema, hyperemia, flattening of the gastric mucosa, swelling, and the production of large amounts of cloudy mucus. However, it does not confirm or deny the presence of helicobacter pylori. To do this, during an endoscopy of the stomach, a biopsy is performed - a collection of mucosal tissue for further research.

Diagnostic methods using biopsy:

Bacteriological culture. An extremely accurate method of detecting bacteria and determining its sensitivity to antibacterial agents is carried out by inoculating bacteria from tissues taken as a result of endoscopy on a special nutrient medium.

Phase contrast microscopy. Microscopic examination of an untreated biopsy specimen from the mucous membrane reveals large colonies of helicobacter pylori bacteria.

Histological examination. A biopsy of the mucous membrane is studied under a microscope; in the presence of H. The study is considered the "gold standard" to clarify the prevalence of bacteria, so it is most often prescribed.

Immunohistochemical method. The enzyme-linked immunosorbent assay (ELISA), which makes it possible to clarify the presence of Helicobacter in the tissues of the mucous membrane taken during a biopsy, is very accurate, but requires high-tech equipment, therefore it is not available to all medical institutions.

Urease test. A gastric biopsy taken during endoscopy is immersed in a urea solution. Then, during the day, the dynamics of changes in the acidity of the solution is recorded. Changing its color to a crimson color signals a helicobacter pylori infection. The more intense the staining, the higher the concentration of bacteria.

Polymerase color reaction (PCR). A very accurate method assesses the reaction of the immune system to the appearance of foreign microorganisms, their number directly on the biological material removed from the stomach.

Analysis for cytology. The low-sensitivity method is to stain the fingerprints taken from the biopsy and study them at multiple magnifications.

If it is impossible to carry out endoscopy and biopsy of the gastric mucosa, the following tests are prescribed:

• Urease breath test. It is carried out during the initial examination and when assessing the effectiveness of the treatment. Air samples are taken from the patient, the level of ammonia and carbon dioxide is assessed in them. After breakfast and the introduction of labeled C13, C14 carbons into the body, air samples are again tested 4 times. When the concentration of labeled carbon in them increases, the test result is considered positive.
• Enzyme immunoassay (ELISA) for the presence of helicobacter pylori in human biological fluids (blood, saliva, gastric juice). The method is used only once in those who contracted for the first time, since antibodies to bacteria persist for several years, it is not used to assess the effectiveness of treatment.

• Stool analysis by polymerase chain reaction (PCR). An accurate method of determining the presence of bacteria requires high laboratory equipment and is rarely used.

Most often, it is enough to carry out one analysis, focusing on the capabilities of a medical institution.

Indications and basic principles of therapy

With the discovery of the main cause of gastritis and ulcers of the stomach and small intestine, caused by the introduction of Helicobacter pylori into the body, a new stage in the treatment of heliobacteriosis began. It is based on eradication therapy - the treatment of bacteria through the complex administration of drug combinations:

• Antibiotics;
• Antibacterial agents;
• Medicines that reduce the acidity of gastric juice.

Drugs to reduce gastric acid secretion deprive bacteria of their habitual habitat.

Indications for the use of antibiotic therapy regimens

Not all carriers of helicobacter pylori are sick with heliobacteriosis, so at the first stage it is important to consult with a gastroenterologist and related specialists on how to treat the bacterium.

There are standards developed by the global gastroenterological community for important indications for the use of eradication therapy:

• Atrophic gastritis (precancer);
• Malt, lymphoma;
• Stomach and duodenal ulcer;
• Condition after removal of a malignant tumor of the stomach;
• The presence of stomach cancer in relatives of the immediate environment.

Recommendations of the world council of gastroenterologists on when to prescribe therapy against helicobacter pylori:

• Functional dyspepsia;
• Reflux - esophagitis (reflux of stomach contents into the esophagus);
• Treatment of pathologies using NSAIDs.

How to reliably and comfortably cure heliobacteriosis?

Standard parameters of eradication therapy at the present stage of development of gastroenterology:

• The effectiveness of treatment is not less than 80% of cases of Helicobacter infection.
• A high level of safety, since for practical use, schemes are not used that have more than 15% of the total number of patients with cases with side effects of drugs.
• The maximum duration of treatment. How much heliobacteriosis is treated: there are courses for 7, 10 or 14 days.
• Reducing the frequency of drug intake due to the use of prolonged-release agents.
• The possibility of easy interchangeability of a drug that did not fit in some parameters within the scheme.

Effective methods of treatment for Helicobacter pylori

Over the course of three decades, several effective schemes have been created that determine how to cure heliobacteriosis. In 2005, the Netherlands hosted the World Gastroenterology Congress, which developed protocols for the treatment of infection. The therapy consists of three lines, or stages. If the first line is ineffective, the second line is assigned. If it does not give a positive effect, third-line drugs are used.

First line of eradication therapy

The first-line regimen contains three drugs: the antibacterial agents Clarithromycin, Amoxicillin, and the proton pump inhibitor Omeprazole or its derivatives. Omeprazole is intended to regulate the acidity of gastric juice. The drug successfully relieves the symptoms of gastritis and ulcers, helps not to adhere to strict dietary restrictions, although treatment still requires dietary adjustments. Amoxicillin, if necessary, is replaced with Metronidazole or Nifuratel.

In some cases, the gastroenterologist adds bismuth preparations to the scheme, which have the following actions:

• Astringent;
• Gastroprotective;
• Anti-inflammatory.

Although most often bismuth preparations are included in the second line of eradication therapy, they also show their positive qualities in the first line: they form a film on the surface of the gastric mucosa that resists pain and inflammation.

How is heliobacteriosis treated in elderly patients on the first line - a softer scheme:

• One antibiotic (Amoxicillin);
• Bismuth preparations;
• Proton pump inhibitors.

The first line course lasts for a week, less often - no more than 2 weeks. In the overwhelming majority of cases (95%) this is enough, and there is no need to go to the second line. If this scheme is ineffective, they proceed to the next stage.

Second line of eradication therapy

At the second stage, a four-component therapy regimen is applied, which includes:

• Two antibiotics containing the active ingredient Tetracycline and Metronidazole;
• Bismuth preparation;
• Proton pump inhibitor.

Antibacterial drugs should not be used in the first treatment regimen, since helicobacter pylori has already developed resistance to them.

What to take as an alternative - the second option:

• 2 antibiotics - active ingredient Amoxicillin and Nitrofuran;
• Bismuth preparation (tripotassium dicitrate);
• Proton pump inhibitor.

Bismuth preparations act as a cytoprotector, protect the mucous membrane, increase its resistance, and serve to prevent relapses. The protective properties of bismuth preparations can be reduced when drinking milk, juices, fruits.

The second line course lasts 10-14 days.

Third line eradication therapy

If the second treatment regimen for heliobacteriosis is ineffective, third-line drugs are used. Before prescribing drugs, the doctor prescribes an endoscopy with a biopsy and a bacteriological culture of a biopsy for its sensitivity to antibiotics. Based on its results, a third treatment regimen is prescribed.

What to take on the third line of therapy:

• The two most effective antibacterial drugs not previously used;
• Bismuth preparations;
• Proton pump inhibitors.

Bismuth tripotassium dicitrate relieves the manifestations of dyspepsia (bloating, heartburn, stomach pain), stimulates the regeneration of the mucous membrane, and exhibits bactericidal properties against Helicobacter pylori.

To maintain normal intestinal microflora, the doctor may recommend taking probiotics, for the prevention of relapses - the use of gastroprotectors.

Read more: Helicobacter pylori treatment protocol

Antibiotics - # 1 remedy for the treatment of helicobacter pylori

First-line antibiotics: Clarithromycin, Amoxicillin (Flemoxin)

According to studies carried out in the 80s of the last century in order to study the sensitivity of helicobacter pylori to antibacterial drugs, in sterile laboratory conditions they are sensitive to the effects of 21 drugs from this pharmacological group.

But in practice, it turned out that some of the drugs are powerless against bacteria due to the aggressive effects of the acidic environment of gastric juice. In addition, not all antibiotics can penetrate deep into the tissues of the mucous membrane of the stomach and intestines, where the helicobacter colonies are located.

Only a few antibacterial drugs have been carefully selected:

• Tetracycline,
• Amoxicillin (Flemoxin),
• Levofloxacin,
• Azithromycin,
• Clarithromycin.

Amoxicillin (Flemoxin)

This broad-spectrum antibacterial agent is included in both the first and second line of eradication therapy for heliobacteriosis. Amoxicillin (Flemoxin) is an antibiotic from the group of semi-synthetic penicillins. Its peculiarity is that the drug destroys only dividing pathogenic microorganisms, therefore it is not prescribed simultaneously with bacteriostatics that suppress the division of microorganisms.

Contraindications to the use of penicillin antibiotics, including Amoxicillin, have a small range.

Absolute and relative contraindications:

• hypersensitivity to penicillins;
• Infectious mononucleosis;
• tendency to leukemoid reactions;
• with caution: pregnancy, renal failure, history of colitis.

Amoxiclav is an antibacterial agent against resistant strains of helicobacter pylori

This is a combined antibiotic, which is a synthesis of two drugs: amoxicillin and clavulanic acid, which increases its effectiveness against bacteria resistant to the action of penicillins. Many strains of pathogenic bacteria have developed resistance to the long-used penicillin and "learned" to destroy its molecules with their enzymes -? -Lactamases.

Clavulanic acid is a β-lactam that binds β-lactamase, while Amoxicillin destroys helicobacter pylori. Contraindications are similar to those for taking Amoxicillin, in addition - severe dysbiosis.

Clarithromycin (Klacid) - antibacterial agent

This drug from the group of erythromycins (macrolides) is often used when prescribing a first-line eradication therapy regimen. It exhibits a minimum of toxic effect. Side effects were recorded in only 2% of patients.

Side effects:

• diarrhea,
• nausea and vomiting,
• rarely: gingivitis and stomatitis,
• very rare: bile stagnation.

Clarithromycin is a very effective drug, helicobacter pylori rarely show resistance to it. It easily interacts with proton pump inhibitors, which mutually reinforce each other.

Contraindications:

hypersensitivity to drugs from the macrolide group.

Use with caution in the following conditions:

• Pregnancy (1 trimester);
• Children's age (up to 6 months);
• Hepatic, renal failure.

Azithromycin - an antibacterial drug as a replacement for Helicobacter pylori

It is a third-generation antibiotic from the macrolide group, prescribed as an alternative for severe side effects of Clarithromycin (diarrhea and others). The number of side effects is only 0.7%, the drug is taken only once a day. Its concentration helps to realize a directed action against helicobacter pylori in the patient's stomach.

Tetracycline is the drug of choice for the second line of eradication therapy

This antibiotic has a wide spectrum of action, but it has increased toxicity, which is manifested in the absence of selectivity not only against helicobacter pylori and other pathogenic bacteria, but also against its own macroorganism.

Negative action of tetracycline:

Violates spermatogenesis;

Causes anemia, thrombocytopenia, leukopenia, inhibiting hematopoiesis;

• Violates the division of epithelial cells;
• Provokes the formation of ulcers and erosions in the stomach, skin dermatitis;
• Disrupts protein synthesis;
• Has a toxic effect on the liver;
• Causes neurological disorders in children, inhibits the growth of bones and teeth.

The antibiotic is not prescribed for children under 8 years old, pregnant women, patients with leukopenia. Tetracycline is prescribed with caution for peptic ulcer, hepatic and renal failure.

Levofloxacin - a drug from the group of fluoroquinolones

This broad-spectrum antibiotic belongs to the fluoroquinolone group and is used in second or third line regimens. This is due to its increased toxicity.

The negative effect of Levofloxacin:

It inhibits the growth of bone and cartilage tissue in adolescents under 18 years of age.

Contraindications:

• Pregnancy;
• Individual intolerance to fluoroquinolones;
• History of epilepsy.

There are reviews from practicing doctors about the resistance of helicobacter pylori to Levofloxacin, so the drug is not always effective.

Helicobacter pylori chemotherapy with antibacterial drugs

Metronidazole for heliobacteriosis

This bactericidal drug belongs to the group of nitroimidazoles and is used in chemotherapy of infections. Its action is based on the destruction of the genetic material of pathogenic cells by the penetration of toxic metabolites of Metronidazole into it.

This is the first remedy that has managed to get rid of heliobacteriosis. Metronidazole in combination with bismuth preparations was used for his treatment by Barry Marshall, the discoverer of helicobacter pylori, who drank the culture of the bacteria and thereby caused gastritis.

With a short course of treatment, the drug does not show toxic properties. It is not prescribed for women in the first trimester of pregnancy, for individuals with individual intolerance.

Possible side effects:

• Allergic dermatitis;
• Metallic taste in the mouth;
• Nausea and vomiting;
• Urine staining red-brown;
• Severe reactions when combined with alcohol.

The resistance of helicobacter pylori to Metronidazole has recently increased, reaching 60% of the total number of patients.

Macmiror (Nifuratel) with heliobacteriosis

An antibacterial drug from the nitrofuran group has a bacteriostatic and bactericidal effect. Macmiror prevents bacteria from multiplying by binding nucleic acids and inhibits biochemical processes in its cells.

With short-term use, it does not have a toxic effect, it is not prescribed for individual intolerance. Use with caution in pregnant women, since the drug crosses the placenta. When breastfeeding and the simultaneous use of Macmirora, there is a high risk of getting the drug into milk, therefore, breastfeeding should be temporarily abandoned.

Possible side effects:

• Allergy;
• Gastralgia;
• Nausea and vomiting;
• Heartburn.

The drug is used in second- and third-line regimens, it is more effective than Metronidazole; helicobacter pylori has not yet developed resistance to it. Since McMiror has shown minimal toxicity in 4-component regimens in children, it is recommended to be prescribed in first-line regimens in children and adults as a substitute for Metronidazole.

Bismuth preparations (De-Nol)

Tripotassium citrate (colloidal bismuth subcitrate) is the active ingredient of the antiulcer drug De-Nol. This drug was used earlier, even before it was included in the eradication therapy regimen. De-Nol's action is based on the creation of a protective film on the walls of the stomach and duodenum, which prevents acidic gastric juice from reaching the damaged areas.

In addition, De-Nol stimulates the accumulation of epidermal regeneration enzymes in the tissues of the mucous membrane, increases the production of protective mucus, which reduces the aggressive effect of gastric juice. This causes epithelialization of erosions and scarring of ulcers.

Studies conducted in the framework of the treatment of helicobacter pylori have found that De-Nol and other bismuth preparations inhibit its growth, transforming the bacterial habitat and acting on it as a bacteriostatic. Thanks to this effect, the bacterium quickly leaves the patient's body.

De-Nol has an advantage over other bismuth preparations - it penetrates deep into the mucous membrane, where there is the highest concentration of pathogenic bacteria. Bismuth destroys the membranes of microbial bodies, accumulates inside cells.

Short courses of drug therapy do not harm the human body, since De-Nol does not penetrate into the circulatory system, it is excreted by the digestive and urinary systems.

Contraindications:

• Individual intolerance;
• Pregnancy and lactation;
• Severe renal failure.

Bismuth preparations penetrate the placental barrier and into breast milk. In case of impaired renal excretory function, bismuth is able to accumulate in the body.

Proton pump inhibitors: Omez, Pariet

Drugs of this group (PPI, proton pump inhibitors) are necessarily included in the first and second line eradication therapy regimen. The mechanism of action of the proton pump is based on blocking the lining cells of the stomach. They actively produce aggressive hydrochloric acid and proteolytic enzymes that dissolve protein.

Omez, Pariet reduce the secretion of gastric juice, which negatively affects bacteria, stimulating its eradication. In addition, a decrease in the acidity of the juice stimulates the speedy regeneration of erosions and ulcers, increases the effectiveness of antibacterial drugs.

To increase the acid resistance of proton pump inhibitors, they are produced in protective capsules that cannot be chewed, they will dissolve in the intestines. In the same place, PPI is absorbed into the circulatory system, and from the blood the inhibitors penetrate into the parietal cells, where they retain their properties for a long time.

Side effects due to the selective action of PPIs are very rare. They manifest themselves as follows:

• Dizziness;
• Headache;
• Nausea;
• Diarrhea.

PPIs are not prescribed for pregnant and lactating women, children under 12 years of age, although Pariet is successfully used to treat children.

Possible complications from antibiotic treatment

Factors that increase the risk of side effects during eradication therapy:

• Individual intolerance to drugs;
• The presence of somatic pathologies;
• The negative state of the intestinal microflora in the initial period of treatment.

Complications of eradication therapy - side effects:

• Allergic reaction to the components of drugs that disappears after withdrawal;
• Dyspeptic symptoms of the gastrointestinal tract (discomfort in the stomach and intestines, taste of bitterness and metal, nausea and vomiting, diarrhea, flatulence). Usually all these phenomena disappear spontaneously after a short time. In rare cases (5-8%), the doctor prescribes drugs for vomiting or diarrhea, or cancels the course.
• Dysbacteriosis. It is more often manifested in patients who previously had gastrointestinal dysfunction, develops during treatment with drugs of the tetracycline series or during therapy with macrolides. A short-term course is not capable of disrupting the balance of intestinal microflora; for the prevention of dysbiosis, it is necessary to often consume fermented milk products: yogurt, kefir.

How to get rid of helicobacter pylori without including antibiotics in the eradication regimen?

There is such an opportunity - you can not use eradication therapy in the following cases:

• Minimum concentration of helicobacter pylori;
• There are no clinical signs of pathologies associated with heliobacteriosis: gastric and intestinal ulcers, atopic dermatitis, type b gastritis, anemia.

For asymptomatic carriers of Helicobacter pylori, a lightweight treatment option is being developed that does not pose a serious burden. It includes drugs to strengthen the immune system and normalize the gastrointestinal microflora.

Bioadditive Bactistatin

Bactistatin helps to normalize the balance of the gastrointestinal microflora, activates the immune response, improves the functioning of the digestive system, intestinal motility. The course of treatment with Baktistatin is designed for 2-3 weeks.

Contraindications:

• Individual intolerance;
• Pregnancy;
• Lactation.

[Video] Dr. Berg - HELICOBACTER PILORI: treatment WITHOUT antibiotics. 6 natural remedies for Helicobacter:

Which doctor treats heliobacteriosis?

If pains and other negative symptoms appear in the stomach, as well as when bacteria are diagnosed, you should consult a gastroenterologist. If children have similar problems, you should consult a pediatric gastroenterologist. In the absence of these specialists, you need to contact a therapist, when treating children - to a pediatrician.

Author of the article: Danilova Tatyana Vyacheslavovna | Infectionist

Education: in 2008 received a diploma in General Medicine (General Medicine) at the Pirogov Russian Research Medical University. Immediately passed an internship and received a diploma of a therapist