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Heliobacter pylori Eradication and Antibiotics

by: Derek Matlock
Pharm.D. Candidate 2017
Washington State University

Heliobacter pylori is a bacteria highly prevalent worldwide and is closely linked to duodenal ulcers (which affect the upper section of your small intestine), gastric ulcers, and peptic ulcer disease. It is also linked to an increased risk of developing gastric cancer in an infected person. Despite being more common in developing countries with poor socioeconomic conditions, the American College of Gastroenterology states that 30-40% of the U.S. population is infected with H. pylori, putting them at risk for conditions such as peptic ulcer disease — which affects the stomach lining — and gastric cancer.

Anitbiotics for Ulcers?

Numerous research studies and testing have not only supported these correlations, but they have also demonstrated the benefits of eradication using medications, specifically antibiotics, for patients suffering from complications of H. pylori.

Prior to the discovery of H. pylori, lifestyle factors such as smoking, eating spicy and acidic foods, and stress, were considered the major causes of ulcers. Thus, the main treatment choices were popular acid suppressing medications such as ranitidine (Zantac®) or omeprazole (Prilosec®). These medications can help improve ulcer-related pain and symptoms, and might even heal the ulcer, but they do not treat the underlying H. pylori infection. Without treating the infection, symptoms and complications are likely to reappear.

Triple Therapy for Ulcers

After the discovery of the bacteria causing these conditions, appropriate antibiotics have been able to eliminate the infection in the majority of individuals, thus resolving the infection and its complications. The following antibiotic regimens are being used, and the triple therapy is the most common.

  1. Triple therapy: Omeprazole 20 mg twice daily + Clarithromycin 500 mg twice daily + Amoxicillin 1,000 mg twice daily or Metronidazole 500 mg twice daily
  2. Concomitant quadruple therapy: Omeprazole 20 mg twice daily + Clarithromycin 500 mg twice daily + Amoxicillin 1,000 mg twice daily + Metronidazole 500 mg twice daily
  3. Bismuth quadruple therapy: Omeprazole 20 mg twice daily + Bismuth subsalicylate 262 mg four times daily + Tetracycline 500 mg four times daily + Metronidazole 250 mg four times daily

Although the triple therapy remains an effective choice, a preference for quadruple therapies may soon become more common, as the risk for patients to fail treatment due to antibiotic resistance becomes a growing concern in the science community.

As the United States prevalence of H. pylori continues to decline, the resistance to antibiotics, specifically Clarithromycin, makes the infection more difficult to treat. As a patient, it is essential to inform your doctor about any recent antibiotics you may have taken, as this may help in the selection of a better treatment option.

References:

  1. American College of Gastroenterology Guideline on the Management of Heliobacter pylori Infection
  2. CDC: Heliobacter pylori Fact Sheet for HCPs
  3. Medscape: Heliobacter pylori Infection
  4. WebMD: What is H. Pylori?

 

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