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Antibiotics against H. pylori-
• Amoxicillin
• Clarithromycin
• Metronidazole (Seconidazole, Ornidazole)
• Tetracycline
• Levofloxacin
Guidelines for H. pylori treatment –
• Use ≥2 antibiotics to decrease the risk of resistance.
• To suppress HCl use PPI (proton pump inhibitors): It also increase effectiveness of antibiotics
• Duration of treatment: 10 – 14 days
Advantage of treatment –
• ↓ GERD
• ↓ Peptic ulcer
• ↓ MALToma (Mucosa associated lymphoid tissue lymphoma)
Note: Risk of barrett’s esophgus is not reduced.
Anti H. pylori regimens | Drugs |
Triple therapy BD x 10-14 days (FMGE July 2025) | • PPI (Omeprazole / rabeprazole / esomeprazole) • Clarithromycin • Penicillin; eg. Amoxicillin (Metronidazole |
Quadruple therapy – Use for clarithromycin resistant cases – Tt of choice in india | • PPI • Bismuth subsalicylate/subcitrate • Tetracycline • Metronidazole |
New regimen | |
Concomitant therapy | Mnemonic: PCAM for 14 days • P – PPI • C – Clarithromycin • A – Amoxicillin • M – Metronidazole |
Sequential therapy | 1st PA for 7 days: • P – PPI • A – Amoxicillin then PCM for next 7 days: • P – PPI • C – Clarithromycin • M – Metronidazole |
Hybrid therapy | 1st PA for 7 days: • P – PPI • A – Amoxicillin then PCAM for next 7 days: • P – PPI • C – Clarithromycin • A – Amoxicillin • M – Metronidazole |
Levofloxacin based triple therapy | Mnemonic: PAL for 7 days • P – PPI • A – Amoxicillin • L – Levofloxacin |
Levofloxacin based sequential therapy | 1st PA for 7 days: • P – PPI • A – Amoxicillin then PML for next 7 days: • P – PPI • M – Metronidazole • L – Levofloxacin |
2 new drugs recently approved-
• Rifabutin
• Furazolidone
Miscellaneous drugs | |
Alginic acid | It works by forming a floating Add on drug for Tt of GERD. |
Anti flatulent drug- • Simethicone • Methyl polysiloxane | MOA: Breaks gas bubbles so gas passes Use for: – Relieves gas – Bloating – Burping |
