PepticUlcerDiseasesTreatment.ppt

* * * * * * * * * * * * * * * * * * * * Short-Course Therapy for Eradication of Helicobacter pylori Treatment regimen Duration (days) Population studied Eradication Rate(%) [Lansoprazole 30 mg BID for 2 days (pretreatment)] + amoxicillin 1g BID + metronidazole 400mg BID + clarithromycin 250mg BID + lansoprazole 30mg BID 5 H. Pylori (+) patients with dyspepsia for 3 months or endoscopically confirmed ulcers 81 ABLES A Z et al. American Family Physician. 2007 Resistance Resistant H. pylori has been documented in cases of failed eradication therapy based on biopsy culture results is of great concern in patients at high risk for complications of H.pylori infection ABLES A Z et al. American Family Physician. 2007 Resistance Resistance rate to clarithromycin is currently 2-30% to metronidazole 15-66% Primary resistance to clarithromycin is a strong predictive risk factor for treatment failure, whereas primary resistance to metronidazole does not always lead to treatment failure ABLES A Z et al. American Family Physician. 2007 Resistance 70 % of patients failing one or more regimens responded well to triple-drug therapy that included: Pantoprazole, amoxicillin, levofloxacin for 10 days ABLES A Z et al. American Family Physician. 2007 Resistance A meta-analysis of current literature on treatment of resistant H. pylori showed benefit in using quadruple drug therapy, including: Clarithromycin + ranitidine + bismuth + amoxicillin (1 g twice daily) therapy, as well as a combination of PPIs (standard dosage for 10 days) + bismuth + metronidazole + tetracycline ABLES A Z et al. American Family Physician. 2007 Recurrence Recurrence of H. pylori infection is defined by: A positive result on urea breath or s