Combination therapy
Combination therapy
- therapies change over time, but regimens designed to treat H. pylori-induced ulcers will always have 3 key components:
- multiple antibiotics for eradication of the bacteria
- a mechanism for treating the pain (usually a PPI) and facilitating healing
- 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
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Many drug-drug interactions have been documented for anti-ulcer medications, including: |