Sequence of medication for H. pylori drugs

China’s current program for the treatment of Helicobacter pylori four combinations of drugs, namely, proton pump inhibitors + bismuth (oral half an hour before meals), 2 antibiotics (oral after meals). 1. Proton pump inhibitors are esomeprazole, rabeprazole, omeprazole, lansoprazole, pantoprazole, epprazole, one of the above can be chosen. The main effect of proton pump inhibitors is to inhibit gastric acid secretion and increase intragastric pH, thus enhancing the effect of antibiotics, including decreasing the minimal inhibitory concentration, increasing the chemical stability of antibiotics and increasing the concentration of antibiotics in the gastric juice in order to improve the eradication rate. 2. Bismuth agent, i.e. bismuth potassium citrate, can turn into bismuth derivatives in the acidic environment of the stomach, thus depositing on the ulcer surface and forming a protective film to avoid further erosion of the ulcer surface, which is conducive to the healing of ulcers and enhancing the barrier effect of the gastric mucosa. 3. Antibiotics for H. pylori include amoxicillin, tetracycline, furazolidone, clarithromycin, metronidazole, and levofloxacin (fluoroquinolones), and 2 of these antibiotics should be chosen according to the patient’s condition. Proton pump inhibitors and bismuth are used to reduce gastric acid secretion before the antibiotics can work, so antibiotics should be taken after meals. If H. pylori infection is suspected, it is necessary to go to the hospital for further relevant examinations, and choose the appropriate medication under the guidance of the doctor to achieve the eradication of H. pylori.