Take your medication strictly on time and in the right amount without fail! –Details make the difference (how to treat?)
The classic protocol for H. pylori eradication is triple therapy, as well as the later development of quadruple therapy and sequential therapy. It is common to see patients in the clinic, with a prescription for triple therapy, not knowing how to use it, and guessing at its use, so that the efficacy of the drug, which should be maximized, does not come into play.
To avoid this, I print out some papers with details of how to take the medication and send them to my patients.
Specific medication regimen for triple therapy.
7-14 days
medicine name
Dosage
Number of times/day
morning
evening
Before/after meal
Rabeprazole Sodium Enteric Dissolve Tablets
20mg (one tablet)
Twice
Six o’clock
Six o’clock
Before meal
Amoxicillin
1g (two tablets)
Twice
Eight o’clock
Eight o’clock
After meal
Clarithromycin dispersible tablets
0.5g (two tablets)
Two times
Eight o’clock
Eight o’clock
After meal
The triple therapy has been largely retired from the history stage due to its early use and more drug resistance. But this classic is the originator and basis of all treatment of HP infection.
From the triplet was derived the quadruplet therapy. It is the additional bismuth agent that can protect the gastric mucosa, which is said to improve the probability of killing by 8-14 percentage points.
The specific dosing regimen of quadruple therapy
7-14 days
drug name
Dosage
times/day
Morning
evening
Before/after meal
Rabeprazole Sodium Enteric Dissolve Tablets
20mg (one tablet)
Twice
Six o’clock
Six o’clock
Before meal
Bismuth potassium citrate
0.3g (one capsule)
Twice
Six o’clock
Six o’clock
Before meal
Amoxicillin
1g (two tablets)
Twice
Eight o’clock
Eight o’clock
After meal
Clarithromycin dispersible tablets
0.5g (two tablets)
Two times
Eight o’clock
Eight o’clock
after a meal
Clinical studies on this subject are proliferating, and in view of the four drugs to be taken for two weeks, sequential therapy has been developed abroad, dividing the different antibiotics into two phases, like a baton, to pass on the germicidal power. The continuation is called sequential therapy. According to biological research, penicillin (amoxicillin) can open the cell wall of HP, facilitating deeper killing at a later stage. An international clinical trial study showed that this method is as effective as quadruple therapy for 14 days, and the probability of killing is over 90%. But sequential therapy uses less drugs than quadruple therapy, which results in less gastric irritation and a lower probability of adverse drug reactions, so, generally, in the outpatient setting, I will use sequential therapy.
Again I give this paper to my Zhou Chao and Xiao Yu.
Sequential therapy for H. pylori infection with Chinese and Western medicine cooperation – standard treatment: 14 days in total
First 7 days
medicine name
Dosage
times/day
Morning
evening
Before/after meal
Rabeprazole Sodium Enteric Dissolve Tablets
20mg (one tablet)
Twice
Six o’clock
Six o’clock
Before meal
Amoxicillin
1g (two tablets)
Twice
Eight o’clock
Eight o’clock
After meal
7 days after
Rabeprazole sodium enteric solution tablets
20mg (one tablet)
Two times
Six points
Six o’clock
Before meal
Clarithromycin dispersible tablets
0.5g (two tablets)
Two times
Eight o’clock
Eight o’clock
After meal
Tinidazole
0.5g (one tablet)
Two times
Eight o’clock
Eight o’clock
After meal
Xiaoyu got the prescription and said, ah, to get up at 6:00 to take the medicine, can I eat later.
I have a serious face, even if the standard is strictly enforced, it may not kill, if you do not listen, it will be more difficult, so take the drug strictly on time and in the right amount, no mistakes.
I want to sleep, can I eat at seven o’clock.
These drugs are administered twice, so, according to the distribution of drugs and metabolism in the blood in the body, it takes 12 hours between, if you eat at 7:00 in the morning, you eat at 7:00 in the evening. This will push back the time of eating.
Oh, I see, that means that if I get up at 9:00 and then take my medication, then I will also take it at 9:00 in the evening, right?
Yes, that’s the theory, so then you don’t take your dinner until 9:30, half an hour after you take your medication, and then you don’t take your antibiotics until 10:00, 10:30, or even 11:00 after that. I am taking a combination of things and setting a time for the patient that is the best time to take the medication.
Okay then, I’ll listen to you.
What you just said, it’s okay to push it back an hour overall, no more.
Great, just take it that way.
Also, you may experience discomfort, nausea, bloating, and bitterness in your mouth from the Clarithromycin, if it is not particularly severe, stick with it for 14 days.
Okay, no problem.
I need to review after taking the medication!
Ah, you need to do a gastroscopy.
That’s not necessary, just blowing.
I’m scared to death, I don’t want to have a gastroscopy anymore.
Do I have to come to you for a follow-up after taking the medication?
Is a gastroscopy that scary? It’s a month after you stop taking the medication.
So it’s today of next month?
No, what day is today, March 6, right, and the medication starts tomorrow, that is, March 7, so the course of Sequential Therapy should be March 7 to March 21, when the course ends, and then come for a review 1 month after stopping the medication, that is, around April 21, to confirm whether H. pylori is killed.
I happened to be abroad on April 21.
Don’t worry, after the 21st, no matter what day it is, after April 21, in the morning on an empty stomach, without eating or drinking, come and blow three times to see if the kill is successful.
Good. After listening to you last time, my boyfriend also had a checkup, and indeed there is, can I take this drug together to kill.
It should be possible, as long as he is not allergic to penicillin.
Yeah, it seems like this one he’s allergic to.
Is it an oral allergy or an intravenous skin test.
I remember it was oral.
Is the allergy serious? If it’s just a rash, you can actually take it. And it works pretty well.
I don’t think so. He was so bad that we had to go to the emergency room last time.
Oh, then you can’t use penicillin, just switch to tinidazole file 0.4 and use the alternative quadruple therapy.
Specific dosing regimen for penicillin allergy quadruple therapy
7-14 days
Drug name
Dosage
times/day
morning
evening
Before/after meal
Rabeprazole Sodium Enteric Dissolve Tablets
20mg (one tablet)
Twice
Six o’clock
Six o’clock
Before meal
Bismuth potassium citrate
0.3g (one capsule)
Twice
Six o’clock
Six o’clock
Before meal
Tinidazole
0.4g (1 tablet)
Two times
Eight o’clock
Eight o’clock
After meal
Clarithromycin dispersible tablets
0.5g (two tablets)
Two times
Eight o’clock
Eight o’clock
After meal
Thank you so much, I prescribed him medicine to take at the same time, however, he has not had a proper concept since he was a child, he takes antibiotics when he has a sneeze, and he always has an infusion, in his words, the germs in his body already know these antibiotics and know the way to deal with them, and I do not know if these will work for him.
If this is the case, it is best to come to the clinic in person to see. First take a course of treatment, if it does not kill, you need to use remedial quadruple therapy with furazolidone and tetracycline instead of these common antibiotics, a different stranger, with a different force, a different hit, and maybe kill.
I am also trying to get him to come to you for a good look.
It is best to see the doctor in person, there are many patients who kill several times without success, or have penicillin allergy, or antibiotic intolerance, and other special circumstances, it is necessary to come to the clinic to ask the doctor, we develop a more targeted and individualized HP infection killing program.
5.2 How about taking Chinese medicine to kill H. pylori?
Jing, a high school classmate of mine, also came to my clinic recently for treatment of her gastric ulcer and HP infection. I also gave her a medication instruction and she got this prescription and scanned it and said, “I have taken all these medicines, but no doctor has ever given me such a clear explanation or combination of them, will they work?
At present, nine out of ten of the patients I treat in the clinic have fully recovered after this sequential therapy, so the certainty is still quite high.
She looked straight shaking her head, you know, in fact, I do not want to take Western medicine, our class on your high school graduation after the University of Chinese Medicine, I want to ask, Chinese medicine can not let me take Chinese medicine to kill H. pylori?
I know she must have read a lot of online writing “pure Chinese medicine treatment”, taking the traditional concept to do the article, because the default Chinese medicine must be good, there must be no side effects, or from the root of the treatment. In line with the QIHUANG philosophy, “diligently seek the ancient teachings, and learn from all prescriptions”, is to objectively understand the advantages and disadvantages of the means of treatment, but also learn from modern medicine, touch and hear, and use the cooperation of Chinese and Western medicine to treat the disease. In other words, what is conducive to the diagnosis and treatment of diseases, what treatment plan is chosen and recommended, without being bound to the Chinese and Western arguments.
Responsible treatment does not lie in Chinese medicine or Western medicine, but in whether a doctor understands and knows how to treat the best.
Looking at Jing’s expectant gaze, I told her that for H. pylori infection, there is no basis to prove that Chinese medicine alone can kill H. pylori, according to the pharmacological study of Chinese medicine, Huang Lian, Dandelion and other drugs have the effect of inhibiting HP, but there is no clinical validation to show that HP can be eradicated, and the world’s prevailing clinical evidence shows that triple quadruple therapy, sequential therapy, and concomitant therapy can effectively The preferred method to complete the eradication of H. pylori is to kill. So you have to use several western drugs, and they combine to clear your H. pylori.
I’ve taken western medicine many times and gotten nauseous and couldn’t eat what to do.
This time is the advantage of Chinese medicine, our department as a national key discipline of integrated Chinese and Western medicine, one of the scientific research topics, is specifically for patients with H. pylori infection who are intolerant to Western medicine, this topic was funded by the National Natural Fund, from the results of the project, we have reason to believe that the cooperation of Chinese and Western medicine is more conducive to the eradication of H. pylori, can increase the patient’s comfort and ensure compliance.
If you are intolerant to the combined use of these antibiotics, you may consider using them together with herbal medicine, which from an outpatient perspective is also likely to increase compliance with eradication and reduce the adverse effects of antibiotics and acid suppressants. In other words, it can help you to carry the impact of this written western medicine.
Generally speaking, antibiotics and their TCM counterparts are about bitter cold, which generally injures the body’s Yang energy, often resulting in a state of cold and dampness trapped in the spleen, such as fear of cold in the spleen and stomach, stomach and stomach discomfort, thick and greasy tongue coating and moist pulse. Of course, individualized treatment is most important, as Yin and Yang, cold and heat, and deficiency and reality require face-to-face consultation.
Not surprisingly, when Jing stretched out her tongue for me to see, I could barely see the tongue texture, but only the white thick moss. Generally speaking, this is a typical tongue sign of dampness trapping the spleen, and some heat is hot, and it turns into yellow moss. If we use the modern mechanism to explain, it is that antibiotics not only kill the invading bacteria in the body, but also hurt the innocent and kill the normal flora of the body, and the imbalance of the normal flora will also lead to indigestion as well as the symptoms of thick tongue moss.
So, it seems that the efficacy of this treatment is definitely there, and at the same time, adverse reactions also appear.
I will develop an individualized treatment plan for you. Based on the sequential therapy, a team of Chinese and Western medicine will be used.
The first one, add a bismuth agent and sequential therapy taken at the same time to protect the gastric mucosa and digestive function, but also to strengthen the synergistic effect of killing H. pylori.
The Western medicine treatment protocol is as follows.
First 7 days
drug name
Dosage
times/day
morning
evening
Before/after meal
Rabeprazole Sodium Enteric Dissolve Tablets
20mg (one tablet)
Twice
Six o’clock
Six o’clock
Before meal
Bismuth potassium citrate
0.3g (one capsule)
Twice
Six o’clock
Six o’clock
Before meal
Amoxicillin
1g (two tablets)
Twice
Eight o’clock
Eight o’clock
After meal
7 days after
Rabeprazole sodium enteric solution tablets
20mg (one tablet)
Two times
Six points
Six o’clock
Before meal
Bismuth potassium citrate
0.3g (one capsule)
Twice
Six o’clock
Six o’clock
Before meal
Clarithromycin dispersible tablets
0.5g (two tablets)
Two times
Eight o’clock
Eight o’clock
After meal
Tinidazole
0.5g (one tablet)
Two times
Eight o’clock
Eight o’clock
After meal
The second one, based on your TCM evidence, gives you a soup remedy. Treatment: warming the spleen and resolving dampness. Add and subtract Ling Gui Zhu Gan Tang and Ping Gastric San. The herbal treatment plan is as follows
Fu Ling 15 Gui Zhi 10 Fried Atractylodes Macrocephala 15 Atractylodes Macrocephala 10
Hou Pu 10 Chen Pi 10 Citrus aurantium 10 Temperate bamboo leaf 10
lotus leaf 10 sand seed 6 roasted licorice 6
7 doses of water decoction
In this case, Fu Ling and Bai Zhu are the ruling herbs for strengthening the spleen and relieving dampness, while Gui Zhi is warm in nature and can warm up water drinks. Pingshangsan uses Atractylodes macrocephala, Houpai and Chenpi to regulate qi and dry up dampness, assisting the above ruler to dry up dampness in the body. Temperate bamboo leaf and lotus leaf can dissolve the water qi in the body, and sand seed can enhance gastrointestinal dynamics and strengthen the spleen and stomach, and together with licorice, they can harmonize all the herbs and play a communicative and coordinating role.
Together, these herbs can strengthen the spleen, warm the yang, and promote dampness, as well as enhance gastrointestinal motility, improve indigestion, and help improve flora.
The tonics are taken half an hour after the western medicine is taken. Overall, it is impossible to kill this cause of HP with herbs alone. The role of herbs is to improve the symptoms of the digestive tract and to reduce the side effects of western medicine. It allows you to tolerate the shock of western medicine.
Jing nodded.
6. Preventing infection or preventing recurrence is most important.
A few days later, Zhou Chao brought a family of five to have HP checkups. Previously, it was always more couples who came to see, and today it was the first time such a large group came to see HP infection, but – this is right, according to the test results, it will be possible to effectively prevent HP.
Xiaoyu also brought his boyfriend and came along for the test.
As long as HP is eradicated by following the regular method, you can face food in a healthy way. It can also eliminate a big hidden danger for the occurrence of digestive diseases.
At the same time, in our lives, try to develop hygienic habits, such as: wash your hands carefully before and after meals, wash your hands carefully when you return home from outside, put things out of the refrigerator before eating them, try to eat at home, and use public chopsticks and spoons when eating out.
It should be noted that prevention is the improvement of lifestyle habits, not the casual use of antibiotics, and cannot be prevented by drugs, any antibiotics have no preventive effect on HP infection, but may harm the normal digestive system. So, you can’t have something to do with antibiotics.
Hearing this, Xiaoyu’s boyfriend lowered his head.
6.2 Review regularly to make sure there is no recurrence.
For patients who have been infected with HP, they should be retested again after six months and the frequency should be changed according to different conditions. This is an effective test to prevent the recurrence of HP infection.
And the most effective for prevention is the habit of healthy living. The greatest benefit of exercise is to strengthen the body’s immunity, which is the body’s own defense, and strengthening the solidity of the defense is the best prevention for HP infection.