GIT - Proton pum inhibitors (PUD) - PUD Triple Therapy

12 important questions on GIT - Proton pum inhibitors (PUD) - PUD Triple Therapy

What are the causes of treatment failure?

Treatment failure can be due to:
  • Low compliance
  • Resistance of HP to antibiotics
    • Resistance of Clarithromycin 7.8%
    • Metronidazole 39.2%

What is the second line therapy for the eradication of H. pylori?

Second line therapy involves a two week quadruple therapy with an 80% eradication rate. It includes:
  • Bismuth subsalicylate 525mg
  • Tetracycline 500mg QID
  • Metronidazole 400mg QID
  • Esomeprazole 20mg BD

What is the composition of rescue therapy 3rd line in case of Rx failure?

Rescue therapy 3rd Line (in case of Rx failure):
  • Twice daily 2 - 4 week course
  • Rifabutin 150mg, Amoxicillin 1g, Esomeprazole 20mg
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What is the standard first line regimen summary for H. pylori eradication?

The standard first line regimen summary for H. pylori eradication is Triple therapy, which includes 2 broad spectrum antibiotics and a PPI for 2 weeks (80–90% eradication rate).

What is the eradication rate and cost consideration for the 3rd line rescue therapy?

  • Eradication rate is 70%
  • But expensive

What is the standard first line regimen for H. pylori eradication?

The standard first line regimen is Triple therapy: 2 antibiotics and 1 PPI for 2 weeks (80 – 90% eradication rate). It includes a Proton pump inhibitor (PPI) + 2 broad spectrum antibiotics.

What are the components of the first option in triple therapy for H. pylori?

The first option includes:
  • Clarithromycin 500mg BD 2 weeks
  • Metronidazole 400mg tid x 2/52 or Tinidazole 500mg bid x 2/52
  • Lansoprazole 30mg or Esomeprazole/Omeprazole 20mg BD 2/52

What are the antibiotic options in the triple therapy for H. pylori?

Options include:
  • Clarithromycin 500mg BD 2 weeks
  • Amoxicillin 1g BD /2 weeks
  • Metronidazole 400mg tid x 2/52
  • Tinidazole 500mg bid x 2/52

What are the components of the second option in triple therapy for H. pylori?

The second option includes:
  • Amoxicillin 1g BD /2 weeks
  • Metronidazole 400mg tid x 2/52 or Tinidazole 500mg bid x 2/52
  • Lansoprazole 30mg or Esomeprazole/Omeprazole 20mg BD 2/52

What PPIs are used in the triple therapy for H. pylori eradication?

PPIs used include:
  • Lansoprazole 30mg
  • Esomeprazole/Omeprazole 20mg BD 2/52

What is the note regarding the combination of antibiotics in triple therapy?

Between the two broad spectrum antibiotics, an anti-protozoa for anaerobic effect is included, which is advantageous, hence the combination.

What is the note regarding the combination of antibiotics in H. pylori treatment?

Note: between the two broad spectrum antibiotics an anaerobic has an advantage hence the combination.

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