Content Reviewers:Lisa Miklush, PhD, RNC, CNS, Jodi Berndt, PhD, RN, CCRN-K, PCCN-K, CNE, CHSE, Gabrielle Proper, RN, BScN, MN, Kelsey LaFayette DNP, RN
The recommended treatment for H. pylori typically involves using a triple- drug therapy regimen, including a proton pump inhibitor or PPI like omeprazole, and two antibiotics, which include clarithromycin plus either metronidazole or amoxicillin.
If triple-therapy fails, clients can be given quadruple-therapy regimen, which again includes a proton pump inhibitor, as well as a mucosal protective agent like bismuth subsalicylate, and the antibiotics metronidazole and tetracycline.
Treatment for H. pylori is usually administered orally, but clients with bleeding peptic ulcers can be given intravenous treatment.
Once administered, proton pump inhibitors act on the parietal cells in the stomach by binding to and inhibiting the H+/K+-ATPase, or proton pumps.
These pumps are involved in the secretion of gastric acid by exchanging potassium ions from the lumen with hydronium from the cells. As a result, proton pump inhibitors ultimately decrease gastric acid secretion.
On the other hand, antibiotics help eradicate the bacterial infection through different mechanisms of action. Clarithromycin is a macrolide antibiotic, which works by binding to the 50S subunit of the ribosome, stopping protein synthesis and bacterial replication.
Metronidazole works by generating free radicals, which can damage various bacterial structures, including DNA, and ultimately cause bacterial cell death.
Amoxicillin is a beta-lactam penicillin, which works by inhibiting cell wall synthesis in bacteria, leading to bacterial death. And tetracycline acts by binding to the 30S subunit of the bacterial ribosome, ultimately stopping protein synthesis and bacterial replication.
Finally, bismuth subsalicylate forms a protective coating over ulcerated tissue, and also increases the production of mucus, prostaglandins, and bicarbonate. In addition, bismuth subsalicylate has antimicrobial properties.
In addition, some clients may experience gastrointestinal disturbances, such as anorexia, nausea, abdominal pain, constipation, or diarrhea.
Also, prolonged acid suppression can decrease the absorption of iron, calcium, magnesium, and vitamin B12. When the gastric juices are less acidic, it also allows other pathogens to survive and invade the gastrointestinal tract.
This makes clients more susceptible to gastrointestinal infection, as well as microaspiration and lung colonization, leading to pneumonia. Other side effects may include a skin rash, and osteoporosis.
Also antibiotics may result in side effects, most notably gastrointestinal disturbances, including anorexia, abdominal pain, nausea, vomiting, diarrhea, and colitis.
Regarding specific side effects, clarithromycin can be ototoxic, which may result in hearing loss. In addition, it can lead to important cardiovascular side effects, including prolongation of the QT interval, ventricular dysrhythmias, and torsades de pointes.
Clarithromycin can also be hepatotoxic and cause liver injury. Now, both clarithromycin or metronidazole can cause a metallic taste in the mouth. Metronidazole may also predispose clients to develop fungal infections like candida.
In high doses, or in chronic treatment, metronidazole may also cause neurological side effects; these include confusion, irritability, restlessness, and depression, as well as peripheral neuropathy, aseptic meningitis, seizures, and encephalopathy.
Now, regarding tetracycline, a very common side effect is phototoxicity, so clients must avoid sun exposure. Tetracycline can also accumulate in teeth and bones, causing permanent discoloration of the teeth and a delay in bone growth.
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