Treatment of peptic ulcer disease has become more effective thanks to the discovery at the end of the last century of the bacterium Helicodacter pylori, which is the main cause of the disease.
As a result, antibiotics began to be used for stomach and duodenal ulcers as part of a comprehensive treatment program. As a result of antibacterial therapy, it was possible to achieve rapid healing of the ulcer and achieve longer remissions. However, these drugs have their own indications and contraindications that you need to know about, and they should be prescribed by a specialist.
Basic principles of drug therapy
The complex of drug treatment for ulcers pursues the following goals: destruction of the causative agent of the disease, normalization of gastric secretion, protection of the mucous membrane from the effects of acid and food factors, relief of spasm and pain, stimulation of reparative processes and protective properties of the body. This is ensured by the use of several drugs with different mechanisms of action.
Groups of traditional therapy drugs
There are proven regimens for the treatment of stomach ulcers, which include drugs from the following main groups:
- Antibacterial agents.
- Normalizing gastric secretion: histamine receptor blockers - Ranitidine , Cimetidine , Roxatidine ; proton pump inhibitors - Lansoprazole , Omeprazole .
- Gastroprotectors that protect the mucous membrane - bismuth dicitrate, sucralfate, De-nol , Vikalin .
- Painkillers and antispasmodics - halidor, No-shpa , Papaverine , beta blockers - Quateron , benzohexonium.
- Stimulators of the healing process (reparants) – Biogastron , Misoprostol , Actovegin , Methyluracil , Histidine .
Also, the course of treatment may include immune stimulants, vitamin complexes, and iron supplements if iron absorption is impaired and anemia is present, which often occurs with ulcers. Treatment programs are compiled individually for each patient, taking into account the presence of contraindications to certain medications. Antibacterial treatment takes the leading place in the first acute phase of the disease.
What antibiotics are the most effective?
Among the huge arsenal of antibiotics, those to which the bacterium that lives in the stomach and causes peptic ulcers are most sensitive were selected. This has been proven both through scientific laboratory studies and many years of clinical practice. Such antibiotics are Amoxicillin , Amoxiclav , Clarithromycin , Tetracycline and the complex antibacterial agent metronidazole.
Characteristics of the antibacterial agents used
Amoxicillin
The drug belongs to the group of semi-synthetic penicillins, has a bacteriostatic effect - it inhibits the growth and stops the reproduction of bacteria. The tablets are taken on an empty stomach, the action time is up to 8 hours, so amoxicillin is taken for stomach ulcers three times a day for 8-14 days.
Amoxiclav
A combination drug containing amoxicillin in combination with clavulonic acid or its salt - potassium clavulonate, which inhibit the enzymes of bacterial membranes and make them more vulnerable to the effects of the antibiotic, enhancing its effect. It is used in tablets or in the form of a suspension prepared from powder. Prescribed before meals in 3 doses per day, treatment duration is 5-14 days.
Clarithromycin
Belongs to the group of broad-spectrum antibiotics – macrolides. In fact, it is semi-synthetic erythromycin. It has greater antibacterial activity than penicillin drugs and is more resistant to gastric acid. However, it is poorly compatible with other medications, so it is prescribed with great caution and taken under the supervision of a doctor. It has a longer effect, so it is taken every 12 hours - morning and evening on an empty stomach, the course of treatment is 5-10 days.
Tetracycline
A popular antibiotic with a wide spectrum of action, it is good because bacteria rarely develop resistance to it. It is effective for 6 hours, so it is prescribed in 4 doses per day before meals. The disadvantage is high toxicity, which limits its use.
Metronidazole
The drug is also known as Metrogyl, Trichopolum, Tinidazole, Bacimex, Efloran, which are widely used to treat protozoal infections - trichomoniasis, amoebiasis, gardnerellosis. Its antimicrobial effect was discovered relatively recently. Prescribed in 2 doses, regardless of food, course duration is from 7 to 10 days.
A number of traditional and proven drugs are being replenished with new ones that are successfully used in the treatment of ulcers: Klacid , Macmiror , Helicotsin , Sumamed .
Amoxicillin: a brief description
Amoxicillin is an antibiotic of the penicillin group, partly of synthetic origin. This ampicillin analogue is active against a large number of the most common pathogens of infectious diseases.
The drug is active against aerobic gram-negative bacteria. Active against aerobic gram-positive bacteria.
Amoxicillin contains only one active ingredient: amoxicillin trihydrate, which is an analogue of ampicillin with a slightly modified formula.
The pharmacological effect of all penicillins is based on their ability to disrupt the synthesis of the cell wall of sensitive bacteria.
The spectrum of pharmacological activity of Amoxicillin is very wide. Microorganisms sensitive to the drug include:
- aerobic gram-positive staphylococci and streptococci;
- gram-negative pathogens of gonorrhea, Escherichia coli, Shigella, Salmonella and Klebsiella.
The antibiotic belongs to the group of penicillin drugs and has a wide range of applications. It promotes the destruction of the bacterial cell wall. The medicine has the following features:
- is quickly absorbed after ingestion, its concentration remains in the blood for a long time;
- the medicine does not have the ability to irritate the mucous membranes of the gastrointestinal tract.
Most often, Amoxicillin is prescribed for gastritis together with Metronidazole. Because the greatest effectiveness occurs when combining several means, they help strengthen each other.
Such measures are used because with monotherapy, the bacteria quickly gets used to this drug and its effectiveness decreases, which worsens the quality of treatment and leads to chronicity of the process. A combination of antibacterial agents of this type will avoid this.
Amoxicillin is taken orally and should be taken with a small amount of liquid before meals. Typically, when treating gastritis, both drugs are used in a dose of 1.5 - 2 g per day. However, the specialist may change the treatment regimen and prescribe a different dosage, depending on the patient’s condition.
Basic treatment regimens for the disease
For the complex treatment of gastric ulcers in the acute period, 3 main schemes are used, depending on the number of components:
- two-component;
- three-component;
- four-component.
Dual-component therapy
Two drugs are prescribed, one of which is antibacterial, the other with gastroprotective and antacid effects: amoxicillin and omeprazole, they are taken 2 times a day for 14 days, followed by a control bacterial analysis. There may be other combinations, for example, metronidazole and de-nol, tetracycline and omeprazole. The effectiveness of this therapy is about 50%.
Triple therapy
This regimen invariably includes 2 drugs - metronidazole and de-nol, the third is an antibiotic (tetracycline, amoxicillin, or clarithromycin). The frequency of administration is the same - 2 times a day, the duration of treatment is 10-14 days, the effectiveness is 70%.
For three-component therapy, a special drug called pilobact is produced, which includes omeprazole, tinidazole, and clarithromycin.
Quadruple therapy
Accordingly, the treatment regimen includes 4 drugs: 2 of them from the group of gastroprotectors and antacids, 2 antibacterial, where metronidazole is an obligatory component. Examples of combinations: metronidazole, tetracycline, de-nol, omeprazole, or another option - metronidazole, amoxicillin, omeprazole, de-nol. Take 2 times a day, duration of treatment is 8-12 days. This scheme turned out to be the most effective with positive results in 95% of patients.
The advantage of multidrug treatment regimens is that antacids reduce the effect of acid on antibiotics, thereby increasing their effect. This allows you to use them not 3-4 times a day, but only 2 - in the morning and in the evening.
Antibiotics in the absence of Helicobacter pylori
All patients with peptic ulcer disease undergo mandatory examination for the presence of Helicobacter in the mucous membrane. There are 3 methods for determining it: direct endoscopic sampling from the stomach, a respiratory test using special markers, and a laboratory immunological blood test based on the presence of antibodies.
If the test result is negative, then antibiotic therapy is not prescribed, because it has many side effects on the body and often causes allergic reactions. And if a bacterium is identified, then, as they say, they choose the lesser of two evils.
Peptic ulcer disease and antibiotics - when their use is justified
Studies of factors that provoke the appearance and development of peptic ulcer disease have shown that in more than 80% of cases the cause of this disease is the activity of the bacterium Helicobacter pylori. To get rid of the consequences of the activity of this bacterium and cure gastric ulcers, various antibacterial therapy regimens have been developed, in which antibiotics play a leading role.
These drugs are of natural or semi-synthetic origin; they inhibit the vital activity of cells of a certain type, which allows for the targeted destruction of pathogenic microorganisms. They are used with caution, carefully analyzing side effects and taking into account contraindications to the use of drugs.
Indications and contraindications for treating ulcers with antibiotics
Antibiotics for the treatment of stomach ulcers are indicated only when positive test results for the presence of Helicobacter are obtained, but even in these cases they are not always prescribed. Antibiotic treatment, despite its effectiveness for ulcers, has the following contraindications:
- Pregnancy, the exception may be its last trimester, when it is not possible to achieve remission of the disease.
- The period of breastfeeding, when an antibiotic that gets into the milk can have a negative effect on the baby.
- Allergy to antibiotics.
- Impaired liver and kidney function.
The characteristics of individual types of antibiotics are taken into account in relation to the patient’s health status. For example, amoxicillin often causes allergies and inhibits hematopoiesis, clarithromycin cannot be prescribed for porphyria (a disorder of pigment metabolism), metronidazole has a teratogenic effect and is contraindicated in pregnant and lactating women, and Klacid is not prescribed for diseases of the nervous system.
What is a stomach ulcer
This disease is one of the most common among all diseases of the digestive system. If we look at statistics, then out of 1000 people, 18 people have gastritis in their stomach.
A stomach ulcer is a serious disorder of the mucous membrane. There can be many reasons for this. The main causative agent is the Helicobacter bacterium. When the disease occurs, the secrecy of the stomach and its general structure are disrupted, and areas of damage appear.
Unfortunately, many people do not take ulcers seriously, since almost every second person has problems with it. But the disease should not be underestimated. It can lead to various kinds of complications, and in some cases, death. Therefore, when the first symptoms appear, you should consult a doctor.
Side effects of antibiotic therapy
Despite the fact that antibiotic therapy promotes rapid healing of the ulcer, there is also a “other side of the coin” - side effects, these include:
- from the stomach - nausea, vomiting, upset stool;
- from the nervous system - headache, dizziness, lethargy, depression, sometimes convulsions develop;
- dysfunction of the liver - a feeling of bitterness in the mouth, pain in the hypochondrium, symptoms of intoxication;
- urinary disorder (urinary incontinence).
The listed effects do not always occur and are expressed to varying degrees, so the specialist prescribes antibacterial treatment, weighing the pros and cons, taking into account the patient’s health status and the presence of concomitant diseases.
Side effects of Amoxicillin
Amoxicillin can cause dysbacteriosis in patients, frequent manifestations of nausea with bouts of vomiting, diarrhea, stomatitis, be accompanied by pain in the anal area, or lead to the development of pseudomembranous enterocolitis.
Taking amoxicillin in excessive quantities causes disturbances in the functioning of the nervous system, in the form of manifestations of excited and anxious states, ataxia and behavioral reactions. Taking higher doses of the drug can cause nighttime insomnia and confusion. Under the influence of this drug, depression may occur in the body, headaches may become more frequent, with convulsive attacks and dizziness.
If the body is hypersensitive to the components of amoxicillin, the following allergic reactions may occur in the body: rhinitis, erythematous rashes and urticaria. In some cases, people experience skin flushing or angioedema.
Taking high doses of Amoxicillin can cause nighttime insomnia and confusion.
Patients often develop conjunctivitis. Feverish conditions and manifestations of anaphylactic shock are also possible with frequent use of this medication.
Self-medication through the use of amoxicillin can cause increased activity of “liver” transaminases. In medicine, there are cases where, under the influence of this drug, the development of hepatitis or damage to the body by cholestatic jaundice was observed. If the drug dosage standards are not observed, a person may have difficulty breathing and experience tachycardia.
Also, improper treatment of the body with this medication can lead to interstitial nephritis and joint pain. The cause of the sudden appearance of candidiasis in the body in the oral cavity and vaginal area is also the use of amoxicillin. If an overdose of amoxicillin occurs, the victim needs to rinse the stomach, give activated charcoal or other saline laxatives.
Sources:
- https://pillsman.org/24394-amoksicillin-pri-gastrite.html
- https://med.vesti.ru/articles/lekarstva-i-preparati/amoksitsillin-instruktsiya-po-primeneniyu/
- https://gastritinform.ru/feostudio.ru/lechenie/klaritromitsin-kak-pit/
- https://belmed.by/directory/drug/34
- https://gastritinform.ru/pishhevarenie.com/preparaty-dlya-zhkt/amoksitsillin-pokazaniya-k-primeneniyu-i-osobennosti-primeneniya/
Reviews
In discussions on forums and special portals dedicated to stomach diseases, you can read reviews from patients who have undergone complex treatment, including antibacterial agents. In general, positive results are noted, many are inclined to believe that metronidazole is the most effective. Only a few experienced minor side effects.
This is confirmation of the fact that antibiotic therapy for ulcers, where the etiological factor is Helicobacter, is effective and should be used in complex treatment.
