However, due to the special colonization site of Helicobacter pylori and the drug resistance of first-line antibiotics, the eradication success rate of the currently recommended standard quadruple therapy is declining, generally below 90%, and even below 70% in some areas with high drug resistance.
Therefore, only by understanding the reasons for the failure of eradication, choosing a suitable scheme and paying attention to some matters needing attention can the success rate of the first eradication be improved.
1, the main reason, antibiotic resistance
At present, there are six kinds of antibiotics recommended for the treatment of Helicobacter pylori infection in China: amoxicillin, clarithromycin, metronidazole, tetracycline, levofloxacin and furazolidone.
The drug resistance rate of amoxicillin, tetracycline and furazolidone is very low or almost non-resistant;
However, the resistance rate of Helicobacter pylori to clarithromycin, metronidazole and levofloxacin showed an upward trend, with the resistance rate of clarithromycin being 20-50%, metronidazole being 40-70% and levofloxacin being 20-50%.
2. Adopt triple therapy.
It is often found that some friends failed in sterilization for the first time. Many people use triple therapy, that is, two antibiotics plus one PPI (prazole).
Triple therapy was eliminated as early as 20 12. At present, the eradication scheme recommended by experts in China is bismuth-containing quadruple scheme.
That is two antibiotics+one bismuth+one PPI.
3, the course of treatment is not enough
Some people stop taking drugs without authorization because of serious side effects; Some people don't pay attention to it and miss it;
Some doctors still follow the old eradication plan and let them take medicine for a week;
The latest scheme is: quadruple scheme 10- 14 days, not less than 10 days, preferably 14 days.
4, drug quality and dosage
Because some doctors prescribe the wrong dose, such as amoxicillin 0.5g once, three times a day; The standard dose should be 1.0g once and twice a day. PPI should be at least twice a day.
Or because the patient did not understand the relationship between dose and content and ate the wrong dose; For example, amoxicillin once1g. If the medicine you buy is 0.5g/ tablet, you need to take 2 tablets.
If it is 0.25g/ tablet, if you eat two tablets, you will lose half the dose.
There is also the problem of drug quality; Some omeprazole needs dozens of tablets in a box of 7 tablets, and some 14 tablets only need more than one tablet in a box; I think the curative effect of drugs with high price and good quality is definitely different.
5. Smoking, drinking and other problems
For example, drinking heavily, smoking and other chronic diseases, such as uremia, respiratory failure, liver cirrhosis, diabetes, etc.
Smoking can reduce the eradication rate (about 10%), especially for remedial treatment. Suggest reducing smoking or quitting smoking.
Alcohol will interfere with the metabolism of some drugs and thus affect the eradication rate;
Drinking alcohol while taking metronidazole and furazolidone will produce disulfiram-like reactions (facial flushing, blurred vision, headache/dizziness, nausea/vomiting, hypotension/shock, etc. ), so alcohol should be absolutely banned.
1, about 15-20% people will fail sterilization. Don't sterilize immediately after the first sterilization failure. In order to restore the sensitivity of Helicobacter pylori to drugs, it is suggested to stop taking drugs for more than 3 months. PPI should be stopped for at least 2 weeks, and other antibiotics should be stopped for 30 days before sterilization.
Symptoms can be treated first.
First, avoid the problems mentioned in the previous section, such as compliance.
2. Antibiotic combination should not be repeated with the last time, and highly drug-resistant clarithromycin, metronidazole and levofloxacin should be avoided as far as possible.
3. Adopt bismuth-containing quadruple therapy, and the course of treatment shall not be less than 14 days; If necessary, it can be extended appropriately;
4. Choose efficient acid inhibitors, such as esomeprazole, rabeprazole and other new generation PPI.
5. You can choose some empirical therapies: for example, choose doxycycline, minocycline, reserpine and sitafloxacin to replace the corresponding antibiotics.
6. Take probiotics and some Chinese patent medicines with antibacterial and side effects.
7. Appropriately increasing the dosage of antibiotics, such as amoxicillin 2g/d to 3g/d and furazolidone 0.2g/d to 0.3g/d, can improve the eradication rate.
8, when necessary, drug sensitivity test, choose sensitive antibiotic combination.
Don't worry about friends who fail to be sterilized twice. This requires a doctor to evaluate whether it is necessary to be sterilized again.
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