For a long time, the first-line treatment of Helicobacter pylori requires taking four drugs, which is the traditional quadruple radical therapy: two antibiotics+proton pump inhibitors+gastric mucosal protective drugs. The overall curative effect of quadruple therapy is good, but some patients fail to take enough courses of treatment because of taking too much medicine or adverse drug reactions, which leads to poor eradication effect.
At the 2nd Shanghai Lujiazui International Digestive Endoscopy Summit Forum on June 5438+February, 2020, some experts shared the high-dose combination therapy for eradicating Helicobacter pylori, and thought that taking two drugs in large doses could also achieve the effect of eradicating Helicobacter pylori. So what is this high-dose combination therapy?
What is the high-dose combination therapy to eradicate Helicobacter pylori?
At present, the empirical treatment scheme recommended by the guideline [1] is a quadruple scheme, including two antibiotics and a proton pump inhibitor (such as esmomeprazole, lansoprazole, omeprazole, pantoprazole, etc. ) and a bismuth reagent.
Compared with triple therapy, this regimen has lower drug resistance rate and higher eradication rate, but it costs more and has higher antibiotic-related adverse reactions. Therefore, scientists have been trying to find a better treatment, and have been trying the best dosage and proportion of two-way therapy (also known as dual therapy). At present, the main research is proton pump inhibitor combined with amoxicillin. The so-called high-dose combination therapy mainly has the following two characteristics:
1) high dose amoxicillin
Amoxicillin is the first choice for the treatment of Helicobacter pylori. Low drug resistance, good bactericidal effect, fast oral absorption, quick onset and high safety range. Even if the dosage is increased, there are few adverse reactions.
Therefore, amoxicillin is the choice of most studies as an antibiotic for high-dose treatment. At present, studies have proved that the daily dose of amoxicillin can be increased to 2 to 3 grams, or the frequency of amoxicillin administration can be increased to 3 to 4 times a day.
2) High dose proton pump inhibitor
Because Helicobacter pylori is in a state of non-replication but living at pH 6 in the stomach, amoxicillin needs to rely on microbial replication mechanism to kill bacteria.
Therefore, increasing the dose of proton pump inhibitors or increasing the frequency of drug use can keep the pH value in the stomach in a neutral state and make amoxicillin play a greater bactericidal role. At present, most experts believe that esmomeprazole (40 mg, twice a day) is the first proton pump inhibitor in combination therapy.
abstract
Medicine is a developing discipline. At present, most studies believe that high-dose combination therapy has high safety, high eradication rate and low adverse reactions, but it cannot be used by patients with penicillin allergy.
It is worth reminding that at present, this combination therapy has not been officially popularized in clinical application, but it is only a new academic research achievement, which needs further large-scale clinical research to prove. It is hoped that a scheme with less drug resistance, fewer adverse reactions and higher eradication rate can be developed in the future.
refer to
[1] General Practice Branch of Chinese Medical Association, Helicobacter pylori group of Gastroenterology Branch of Chinese Medical Association. Guidelines for the diagnosis and treatment of Helicobacter pylori infection in grass-roots units (20 19) [J]. China Journal of General Medicine, 2020, 05:397-402.
Feng Xinyi, Deng Bin Zhang Yunren. Research progress on eradication of helicobacter pylori infection by high-dose dual therapy. World chinese journal of digestology. 2020； 28( 17):847-85 1.