Discussion Question 1 Mike is a 46-year-old who presents with a complaint of "heartburn" for 3 months. He describes the pain as burning and it is located in the epigastric area. The pain improves after he takes an antacid or drinks milk. He has been taking either over-the-counter (OTC) famotidine or ranitidine off and on for the past 2 months and he still has recurring epigastric pain. He has lost 6 lb since his last visit. Assessment His examination is unremarkable. His blood pressure (BP) is 118/72. Laboratory values are normal complete blood count (CBC) and a positive serum Helicobacter pylori test. What would you prescribe initially? How long would you prescribe these medications? Initially I would think to start a triple therapy antibiotic which consists of two antibiotics and a proton pump inhibitor (PPI) like omeprazole. The most common triple antibiotic therapy is a combination of amoxicillin, clarithromycin, and selected PPI. For the last two decades, the recommended treatment for H. pylori eradication is the standard triple therapy but the efficacy of these triple regimens has decreased lately to rates lower than 70%, due to H. pylori resistance to key antibiotics, mainly clarithromycin, but also metronidazole and levofloxacin (Goderska, Agudo Pena, & Alarcon, 2018). Resistance to clarithromycin was reported at 17% and increasing worldwide. A recent consensus report on H. pylori eradication therapy recommends that only regimens that reliably produce eradication rates of ≥90% should be used for empirical treatment. These regimens include a 14 day triple antibiotic therapy and 10 to 14 days bismuth quadruple therapy. Taking into consideration whether there is a resistance of clarithromycin in Georgia and the United States, I would select my treatment. If there is no known resistance of clarithromycin, I will stick with the standard antibiotic triple therapy. If there is known resistance then I would treat with a 14 day bismuth quadruple therapy. This therapy contains two antibiotics, tetracycline
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- Fall '17
- Helicobacter pylori, H. pylori eradication