Helicobacter pylori: 2 drugs with good effects and few side effects

Helicobacter pylori: 2 drugs withgood effects and few side effects. Helicobacter pylori is also known as cancer bacteria because it is related to the occurrence of gastric cancer. At the same time, it is also closely related to gastrointestinal diseases such as gastric ulcer, gastritis, and duodenal ulcer. In China, the average infection rate of Helicobacter pylori has exceeded 50%. Therefore, experts at home and abroad suggest that in most cases, it is best to eradicate Helicobacter pylori infection.

For a long time, the first-line treatment of Helicobacter pylori requires 4 kinds of drugs, which is the traditional quadruple root treatment: 2 kinds of antibiotics + proton pump inhibitor + gastric mucosal protective drugs. The overall effect of quadruple therapy is good, but some patients have not adhered to the course of treatment due to excessive intake of drugs or adverse drug reactions, resulting in poor eradication effects.

At the second Shanghai Lujiazui International Digestive Endoscopy Summit Forum in December 2020, some experts shared high-dose dual therapy for the eradication of Helicobacter pylori. They believed that high-dose two drugs can also achieve the eradication of Helicobacter pylori. Effect, so what exactly is this high-dose dual therapy?

What is high-dose dual therapy to eradicate Helicobacter pylori?

The current guidelines [1] recommended the empirical eradication of Helicobacter pylori therapy is a quadruple regimen, including two antibiotics, a proton pump inhibitor (such as esomeprazole, lansoprazole, omeprazole , Pantoprazole, etc.) and a bismuth agent.

This approach has lower drug resistance rate and higher eradication rate than triple therapy, but the cost is higher and antibiotic-related adverse reactions are higher. Therefore, scientists have been exploring better treatment options, and have been trying the best dose and ratio of dual therapy (also known as dual therapy). At present, the main research is the dual therapy of proton pump inhibitor combined with amoxicillin. The so-called high-dose dual therapy has the following two characteristics:

1) High dose amoxicillin

Amoxicillin is the antibiotic of choice for the treatment of Helicobacter pylori. It has low drug resistance, good bactericidal effect, rapid oral absorption, quick onset, and high safety range. Even if the dose is increased, adverse reactions are relatively few.

Therefore, amoxicillin as an antibiotic for high-dose therapy is the choice of most studies. Current studies have shown that it can increase the daily dose of amoxicillin to 2 to 3 grams, or increase the frequency of amoxicillin administration to 3 to 4 times a day. Times.

2) High-dose proton pump inhibitor

Since Helicobacter pylori is in a non-replicating but viable state at pH<6 in the stomach, amoxicillin needs to rely on microbial replication mechanisms to kill bacteria.

Therefore, increasing the dosage of proton pump inhibitors or increasing the frequency of medication can maintain the pH of the stomach in a neutral state, allowing amoxicillin to exert its bactericidal effect. At present, most experts believe that esomeprazole (40 mg, twice a day) is the first proton pump inhibitor in dual therapy.

Sum up

Medicine is an ever-evolving subject. At present, most studies believe that high-dose dual therapy has high safety, high eradication rate and low adverse reactions, but patients with penicillin allergy cannot use it.

It is worth reminding that at present, this 2-combination therapy has not been formally promoted in clinical application. It is just a new academic research result, and further large-scale clinical research is needed to prove it. It is hoped that in the future, a solution with fewer drug resistance rates, fewer adverse reactions and higher eradication rates can be developed.

(source:internet, reference only)

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