Use of antibiotics in the treatment of stomach Helicobacter pylori

Treatment of Helicobacter pylori infection is important in the management of digestive disorders. However, it is necessary to have correct and appropriate indications, that is, to kill only when necessary, in order to limit antibiotic resistance.

1. Antibiotics for Stomach Helicobacter pylori The most important antibiotics used in the treatment of H.pylori include clarithromycin, metronidazol, amoxicillin and levofloxacin.
1.1. Clarithromycin Clarithromycin is a macrolide antibiotic that inhibits protein synthesis by binding and retarding bacterial ribosome activity. Drug Interactions: Because of the cytochrome P450 inhibitory effect, it affects the metabolism of many other drugs, leading to increased concentrations of drugs metabolized by this enzyme and increased drug toxicity (eg, lipid-lowering agents, anticoagulants). Undesirable effects: The most common are gastrointestinal side effects, including nausea, vomiting, abdominal pain, diarrhea (when taken orally), thrombophlebitis (for intravenous injection). circuit). The drug is extensively metabolized by the liver, so there is a risk of hepatitis or cholestasis. Clarithromycin has a very low rate of causing deafness and arrhythmias. Currently, the rate of H. pylori bacteria resistant to the antibiotic Clarithromycin has increased quite significantly and there is a clear difference in each country, in Vietnam it is 33%. Therefore, the treatment of H. pylori with Clarithromycin encounters many difficulties. 1.2. Metronidazol Metronidazol is an antibiotic of the 5-nitro-imidazole group. Mechanism of action: Selectively acts on anaerobic bacteria and also on hypoxic cells. Accordingly, the nitro group of the drug is reduced by special electron transport proteins of HP, creating toxic products, which change the bacterial DNA structure. Drug interactions: Synergistic effects with beta-lactam antibiotics and aminoglycosides. Undesirable effects: Nausea, metallic taste in mouth, skin lumps, nervous disorders, leukopenia and hypotension. Currently, the rate of HP resistant to metronidazole is quite high, in Vietnam up to 69.9% out of 103 strains. 1.3. Amoxicillin Amoxicillin is a beta-lactam antibiotic used in a 3-drug regimen for the treatment of H. pylori. Mechanism of action: Inhibiting bacterial cell wall formation, lysis or deformation of bacteria. Unlike clarithromycin and metronidazole, amoxicillin resistance rates are low worldwide.

1.4. Levofloxacin In the face of clarithromycin resistance, a broad-spectrum quinolone antibiotic is used instead, which is levofloxacin. The eradication rate of Helicobacter pylori from levofloxacin-containing regimens can reach 90%. Adverse effects occur with an incidence of about 10%, including nausea, vomiting, diarrhea, skin allergies, increased intracranial pressure (dizziness, headache, confusion, convulsions, hallucinations). . In young children, side effects are common, with muscle pain, pain, and swelling in the joints. In addition, taking Levofloxacin has a risk of rupture and rupture of load-bearing tendons. Not suitable for children under 18 years of age, pregnant and lactating women. Not for people with G6PD deficiency. Due to the rapid development of secondary quinolone-resistant H. pylori, levofloxacin is generally not recommended for initial use. The drug is often used as a second-line regimen, after failure of the first regimen with the antibiotics metithidycin and/or metronidazole.

2.1. Classical 3-drug regimen In the 1990s, 3-drug regimen was the gold standard in the treatment of gastric H.pylori infection. The 3-drug regimen includes: clarithromycin, 1 proton pump inhibitor, and amoxicillin/metronidazol. The increasing rate of resistance to this group of antibiotics, especially to the main antibiotic - clarithromycin, has reduced the effectiveness of this regimen in treating HP. 2.2. 4-drug regimen 4-drug regimen includes 2 antibiotics tetracycline and metronidazol, combined with bismuth and PPI proton pump inhibitor for 14 days. This is the preferred regimen of first choice for areas with a high rate of clarithromycin resistance, and as second-line therapy when treatment failure with the classic 3 drugs against HP. The 4-drug combination in this regimen works completely independent of clarithromycin. In addition, the use of high doses and prolonged treatment with metronidazole minimizes the impact on drug-resistant strains of bacteria and improves the eradication rate of HP, even in areas with high rates of resistance to H. this antibiotic. 3. Drug resistance and treatment of HP infection The cause of high antibiotic resistance stems from the widespread use of antibiotics in other diseases unrelated to HP, or the use of antibiotics for targeted purposes. kill HP bacteria but do not comply with the indications or do not follow the treatment regimen. According to recommendations from the Vietnam Gastroenterology Association, when the rate of antibiotic resistance to clarithromycin in the population is high above 20%, the standard 3-drug regimen should not be used, but must be replaced with another regimen.
Thus, although HP bacteria are the main cause of peptic ulcer disease and gastric cancer, not all patients infected with HP bacteria present with the disease. Therefore, it is necessary to use antibiotics to treat HP exactly as indicated to avoid causing cross-resistance of antibiotics from one person to another, leading to a situation where later when it is necessary to treat HP bacteria, the antibiotic is no longer available. function.

Above is the important information about the use of antibiotics in the treatment of stomach Helicobacter pylori. Knowing the information will help the treatment process achieve better results.
If you have any questions or need specific advice about your health, you can directly contact Vinmec International General Hospital for examination and instructions from a specialist doctor.