Discussion Question 1
Mr. Mike presents with signs and symptoms of peptic ulcer disease (PUD) and is has a positive test for H.
pylori. H. pylori is a bacterium that lives in the lining of the stomach. This bacterium releases toxins that
causes inflammation and damages(ulcers) the lining of the duodenum and stomach (Woo & Robinson,
2016) It is critical for this bacterium be eradicated. (Woo & Robinson, 2016) According Woo & Robinson,
the treatment plan should be to eradicate the H. pylori, heal the ulcers caused by the bacteria in his
duodenum, treat complications if the need arises, institute preventive treatment in order that re-
infection does not occur, and eliminate his presenting symptoms.(Woo & Robinson, 2016) Mr Mike is
already taking over the counter Histamine 2 receptor antagonist famotidine or ranitidine apparently with
no favorable response. Mr. Mike’s conditions much more than this as he has an infection that calls for
antibitoics.
According to guidelines, a patient should be asked about previous antibiotic they have exposed prior to
prescribing to ensure that failed drug is not being used.(Chey, Leontiadis, & Howen, 2017) To follow
guidelines and to promote compliance, I will initially
prescribe what is called the triple therapy a trio of medication that has had success and it is popular
because of its ease of use and its cost.(Woo & Robinson, 2016) Assuming he has no allergies and has not
been on any antibiotic he will be taking
Proton Pump inhibitor: Aciphex 20 mg bid x 14 days Then for 8 to 10 weeks
Antibiotics Clarithromycin 500 mg Bid x 14days
Antibiotics Amoxicillin 1gm bid X 14 days
What other possible meds could you prescribe to assist with the side effects from the medications
prescribed?
Fifty percent of patients while on the triple therapy for H. Pylori experience side effects. (UpToDate)
These side effects usually leads to noncompliance. (UpToDate) Most of the side effects are mild. (Woo &
Robinson, 2016) Most common side effect of the treatment is headache and diarrhea. (Woo & Robinson,
2016) In addition clarithromycin causes altered taste and gastric upset and in patients taking amoxicillin
can develop a rash, hives and glossitis. Patients will be treated with a probiotic to counter the effect of
the diarrhea. According to Woo and Robinson, the probiotics restore the normal flora in his stomach that
was infected by the bacteria and reduce the diarrhea caused by the antibiotic. (Woo & Robinson, 2016)
