H.pyloriInfection

Page | 1

Case Study H.Pylori Infection

Robert Alonso

Florida National University

March 18, 2020

New therapy guidelines for H. Pylori treatment and patient education

1.

· Pepto Bismol [a bismuth subsalicylate] 525mg qid

· Metronidazole 250mg qid

· Adoxa [a tetracycline] 500mg qid

· Omeprazole [a proton pump inhibitor] qid

NB: the above medication is given for 7

–

14days.

2.

· In quadruple therapy the prolonged therapy treatment of beyond seven days is recommended as it enhances efficacy.

· The quinolones like levofloxacin should be used as substitutes for clarithromycin especially in proton pump inhibitor therapy.

· As long as quadruple therapy is concern, the therapy based on bismuth sub-citrate, tetracycline, omeprazole and metronidazole is best relative to triple therapy. Bismuth based quadruple therapy can be used as both primary and second line therapy in clarithromycin resistance cases.

· Sequential treatment therapy as new quadruple therapy is made up of a proton pump inhibitor, clarithromycin and nitoimidazole given for 5 days after proton pump inhibitor plus amoxicillin is already given for 5 days thus whole treatment duration is 10 days. In terms of eradication rate, this treatment is more efficient than the common triple therapy.

· In our common standard proton pump inhibitor triple therapy which had a duration of 7 days, the duration has been extended to 14 days so as to get rid of reduction in eradication rate.

· Visually, rifampicin, amoxicillin and tetracycline are not affected by resistance as compared to clarithromycin.

· Standard triple therapy of proton pump inhibitor plus clarithromycin and metronidazole or amoxicillin are considered first-line option worldwide.

· The best option of treating antimicrobial resistance in this therapy is using proven antibiotic regimen that has correct dosage and correct duration of treatment.

PATIENT EDUCATION

· Patients should be counseled on how to stop risk factors that lead to or increase dyspepsia and peptic ulcers like smoking, taking alcohol and stress-full behaviors.

· Patient with stomach ulcers should avoid NSAIDS drugs and tobacco at all cost for it enhances this condition.

· Patient should take drugs consistently and completely as indicated by the doctor’s prescription.

–

References

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1071674/

https://academic.oup.com/pcm/article/2/2/77/5520678

CASE STUDY 2

CASE STUDY H. PYLORI

Florida National University

Ariel Lopez

March 18, 2020

Introduction

H. Pylori is a bacteria that is found in the stomach. This disease is capable of causing other digestive issues such as stomach cancer as well as ulcers. The bacteria affect the protective tissue that is in the stomach. In addition, it causes changes to the duodenum and stomach. Some of the signs and symptoms include nausea, bloating, vomiting, lack of appetite, and dark or tar colored stool, (Pachathundikandi, et al., 2019). Research shows that up to twenty percent of a patient with this disease do not get cured after completing the first course of treatment. In this case, the patient was given clarithromycin for fourteen days, Cipro for two weeks and Omeprazole for two week

If the medication does not work, it is advisable to avoid using the same antibiotics when retreating the patient. Bismuth quadruple therapy is recommended for a patient who initially received clarithromycin, (Li, et al., 2017). When deciding on the salvage therapy, the patient antibiotic exposure, as well as the local antimicrobial resistance data, should be considered. Bismuth quadruple therapy or levofloxacin for two weeks is the most preferred salvage regimens. Other regimes include concomitant therapy for ten days to two weeks, rifabutin for ten days, and high dose dual therapy for two weeks. Clarithromycin is not preferred for salvage therapy.

Conclusion

Due to the decrease in the success rate of H. Pylori eradication therapy. Continuous infection is not uncommon after treatment. Fecal antigen testing, urea breath test, and biopsy-based test can be used to determine the treatment success. It is important to test the patient after four weeks, (Suzuki & Mori, 2018). After the completion of antibiotics and after therapy has been withheld for seven to fourteen days. It is essential to discuss the challenges and benefits of the therapy. Factors such as smoking and diabetes mellitus play an important role in treatment failure.

Reference

Li, T. H., Qin, Y., Sham, P. C., Lau, K. S., Chu, K. M., & Leung, W. K. (2017). Alterations in gastric microbiota after H. pylori eradication and in different histological stages of gastric carcinogenesis. Scientific reports, 7, 44935.

Pachathundikandi, S. K., Tegtmeyer, N., Arnold, I. C., Lind, J., Neddermann, M., Falkeis-Veits, C., … & Sticht, H. (2019). T4SS-dependent TLR5 activation by Helicobacter pylori infection. Nature Communications, 10(1), 1-11.

Suzuki, H., & Mori, H. (2018). World trends for H. pylori eradication therapy and gastric cancer prevention strategy by H. pylori test-and-treat. Journal of gastroenterology, 53(3), 354-361.

Running head: CASE STUDY DISCUSSION 1

CASE STUDY DISCUSSION 4

Case Study Discussion

Idalmis Lopez

Florida National University

March 18, 2020

The recent guideline by the American College of the Gastroenterology (ACG) which was published provides the updated guideline for the treatment of the Helicobacter pylori infection. Two types of regimens focus on the management of the patient with the infection. The first-line therapy according to the recommendation by the ACG is the bismuth-based quadruple which contains the bismuth, tetracycline, metronidazole, and the PPI which is taken for two weeks (Randel, 2018).

When first-line therapy fails to help the patient improve, then the second regimen is recommended. Second-line therapy involves the use of concomitant therapy that involves the use of clarithromycin, amoxicillin, metronidazole, and the PPI for 10 to 14 days. This type of therapy is a clarithromycin triple therapy with the addition of the metronidazole (Randel, 2018).

The effectiveness of these drugs is depending on the proper assessment of the patients. Therefore, the physician needs to assess the patient and inquire whether the patient has been exposed to the macrolide antibiotic and whether the patient is allergic to penicillin. It is also important to consider the local antibiotic resistant pattern (Randel, 2018).

Patient education

The patient needs to be educated on the importance of revealing full details of the drugs that have been used in the past. This is important in the prevention of possible complications such as allergic reactions. It also helps in changing the medication in case the previously used failed to work effectively towards the healing of the patient. The patient is also taught on the importance of adherence to the full regimen to prevent the possibility of failure in the eradication of the bacteria as a result of the antibiotic-resistant. The patient is also taught to avoid alcoholic beverages since there is alcohol interaction with the metronidazole. The patient is also taught to avoid some foods such as spicy since they increase the survival of the bacteria i.e. the acidic environment for the bacteria in the stomach. Foods such as meat with high-fat content must also be avoided by the patient to help in self-care management during the treatment process (Myran & Zarbock, 2018).

References

Myran, L., & Zarbock, S. (2018). H. pylori Infection: ACG Updates Treatment Recommendations. Gastroenterology, 43 (4), 27-32.
Randel, A. (2018). H. pylori Infection: ACG Updates Treatment Recommendations. American Family Physician, 97 (2), 135-137.