after PPI therapy is discontinued or patients with complications such as

After ppi therapy is discontinued or patients with

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PEPTIC ULCER Drug 1 Drug 2 Drug 3 Drug 4 Triple therapy Proton pump inhibitor bid Clarithromycin 500 mg bid or metronidazole 500 mg bid Amoxicillin 1 g bid Triple therapy Proton pump inhibitor bid Clarithromycin 500 mg bid Metronidazole 500 mg bid Quadruple therapy Proton pump inhibitor bid or Ranitidine 150 mg bid Metronidazole 250 mg qid Tetracycline * 50 0 mg qid Bismuth subsalicyl 525 mg qi
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33Levofloxacin-based triple therapyProton pump inhibitorbidLevofloxacin 250–500 mg bidAmoxicillin 1 gm bidDrug Treatment Protocols forHelicobacter pyloriEradication*Children <8 yr should not take tetracycline. Other treatment regimens with dosage adjustments for children are acceptable. Some come with drugs grouped in packets.Proton pump inhibitors include esomeprazole 40 mg, lansoprazole 30 mg, omeprazole 20 mg, pantoprazole 40 mg, rabeprazole 20 mg.Source: Crowe, 2013b; Lew, 2009.Duodenal and gastric ulcers recur in up to 80% of patients treated with drugs to reduce gastricacid but not treated for eradication of H. pyloriinfection. By comparison, 6% to 15% of patientshave recurrent ulcers when their H. pyloriinfection is cured.Maintenance therapy with an antisecretory agent is not generally required after eradicationof H. pylori.However, it is prudent to prescribe maintenance therapy for certain high-riskgroups: smokers; patients older than 60 years; patients with chronic obstructive pulmonarydisease, coronary artery disease, or renal failure; patients with a history of bleeding or perforatedulcer; patients with persistent symptoms; and those who must take NSAIDs or other ulcerogenicdrugs.Patients with gastric or duodenal ulcers who fail to become symptom-free or who developcomplications such as GI bleeding while on antisecretory therapy require a referral to agastroenterologist. Surgery is contemplated for gastric ulcer patients.Lifestyle ModificationsEvidence is lacking that dietary modifications affect the course of PUD. Frequent small mealsand decreased consumption of spices, alcohol, caffeine, and fruit juices have never beendemonstrated to affect healing. Dietary changes should be directed at those substances that causesymptoms in each particular patient. An important lifestyle modification is smoking cessation.Smoking both increases the risk for gastric and duodenal ulcers and delays their healing (Soll &Vakil, 2012).Aspirin and NSAIDs are known to be ulcerogenic. Their use should be discouraged and a highindex of suspicion for NSAID and aspirin use is required because patients do not always reportOTC use (Soll & Vakil, 2012).Drug TherapyCurrently, the FDA approves eight treatment regimens; however, several other combinationshave been used successfully. Regimens include triple or quadruple drug therapy with a variety of
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