infectious disease header

Infection
Gastric Ulcer Possible therapeutic alternatives
H. pylori
( Helicobacter Pylori )		  
TREATMENT REGIMENS 
THREE DRUG REGIMENS 
Proton pump inhibitor (PPI) orally twice daily + Clarithromycin 500mg orally twice daily + Amoxicillin 1gm orally twice daily [Available as Prevpac using PPI lansoprazole]. Eradication 85-90%. Duration 10-14 days*
Bismuth subsalicylate 525mg four times daily + Tetracycline 500mg four times daily + Metronidazole 500mg orally 3 to 4 times daily.  Duration=14 days*. Cheapest option (about $15), but efficacy reduced without PPI.
Proton pump inhibitor orally twice daily + Clarithromycin 500mg orally twice daily + Metronidazole 500mg orally twice daily. Duration 10-14 days [for PCN allergic pts]
Ranitidine bismuth citrate 400mg orally twice daily + Clarithromycin 500mg orally twice daily + Amoxicillin 1gm orally twice daily Duration= 7-10 days
PPI orally twice daily + Amoxicillin 500mg orally twice daily-orally three times daily + Metronidazole 500mg orally 2 or 3 times daily x 10-14d
Ranitidine bismuth citrate 400mg orally twice daily + Clarithromycin 500mg orally twice daily + Metronidazole 500mg orally twice daily. Duration= 7 days
* denotes FDA approved regimens. PPI's = omeprazole 20mg, lansoprazole 30mg, pantoprazole 40mg, rabeprazole 20mg, esomeprazole 40mg ALL PO orally twice daily.
TWO DRUG REGIMENS (FDA APPROVED) 
Dual therapy well-studied, but lower eradication rates (60-85%) make them second tier options.
PPI + either clarithromycin 500 mg orally three times daily OR Amox 1gm orally twice daily for 2 weeks then PPI for 2 more weeks (PPI = omeprazole 40mg QD or lansoprazole 30mg orally three times daily)
Ranitidine bismuth citrate (RBC) 400 mg orally twice daily + clarithromycin 500 mg orally three times daily OR orally twice daily for 2 weeks then RBC for 2 more weeks
FOUR DRUG REGIMEN
Proton pump inhibitor orally twice daily + Bismuth subsalicylate 525mg four times daily + Tetracycline 500mg four times daily + Metronidazole 500mg orally 3 to 4 times daily. Duration 2 weeks

Images

Gastric Ulcer
Bleeding Ulcer

References - Infectious Disease Section
Infectious Disease References

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