Combination therapy

therapies change over time, but regimens designed to treat H. pylori-induced ulcers will always have 3 key components:
1. multiple antibiotics for eradication of the bacteria
2. a mechanism for treating the pain (usually a PPI) and facilitating healing
3. long duration (10 days - 2 weeks), which can cause problems with compliance

current standard is TRIPLE THERAPY:
- PPI + (CLARITHROMYCIN + AMOXICILLIN or TINIDAZOLE for 10 days)

due to an increase in antibiotic resistance, the current triple therapy is only 75-80% effective, which has lead to the development of alternative therapies that are prescribed when the standard triple therapy has proven ineffective:
- PPI + BISMUTH + TETRACYCLINE + METRONIDAZOLE for 14 days
- PPI+ AMOXICILLIN + RIFABUTIN+ CIPROFLOXACIN for 10 days

when considering drug combinations, keep OTC medications in mind! If you don't relieve their pain, your patients will self-medicate
pharmacokinetics of weak acids and bases will be affected by any anti-ulcer drug that either:
- affects luminal pH (PPIs, H₂ blockers, antacids)
- alters urine pH (systemically absorbed antacids)

ANTACIDs will chelate TETRACYCLINE (and many other orally administered drugs), reducing their efficacy

SUCRALFATE requires an acid environment to be activated, therefore it cannot be given with PPIs, H₂ blockers or antacids

Many drug-drug interactions have been documented for anti-ulcer medications, including:
1) among the drugs within the anti-ulcer regimens (TETRACYCLINE + antacids, for example) and
2) alterations in the pharmacokinetics of other drugs a patient is taking (especially in cases where luminal pH is critical for absorption, as both increases and decreases in bioavailability have been documented).

The fact that many of these drugs are available OTC must be considered also.

2016 Treatments for Acid-Peptic Diseases

Combination therapy