Treatment for Helicobacter pylori: Nursing pharmacology

Definitions & Key takeaways

Helicobacter pylori, or H. pylori for short, is a bacterium that can cause inflammation of the stomach lining; and can result in peptic ulcers. 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 a 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.

When caring for a client prescribed treatment for H. pylori, nursing considerations consist of obtaining baseline assessment and the client's recent diagnostic information, as well as monitoring for side effects or therapeutic outcomes. Client- teaching includes proper administration and length of treatment, as well as potential side effects, recommended dietary changes, and when to contact their healthcare provider.

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Introduction0:00–0:54

Helicobacter pylori, or H. pylori for short, is a bacterium that can cause inflammation of the stomach lining; and can result in peptic ulcers.
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.

Mechanism of action0:54–2:22

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.Side effects of proton pump inhibitors can include headaches, dizziness, fatigue, and blurred vision, as well as dry mouth, increased thirst, and hiccups.

Side effects2:22–5:25

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.
Some clients on these antibiotics may also develop a skin rash, urticaria, and pruritus, as well as severe reactions like Stevens-Johnson syndrome or toxic epidermal necrolysis.
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.
Amoxicillin can also cause seizures and other side effects, such as a black hairy tongue, as well as anemia, eosinophilia, and bone marrow depression, which can lead to pancytopenia.
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.
Additionally, tetracycline can be nephrotoxic, and can cause Fanconi syndrome. Tetracyclines are also not very shelf-stable, and using them after their expiration date can cause liver failure.
Finally, bismuth subsalicylate can cause the tongue and stool to turn black temporarily. In addition, since it contains salicylate, it is associated with ototoxicity.Now, as far as contraindications go, omeprazole should be avoided during pregnancy, while other proton pump inhibitors are safe to use.

Contraindications & cautions5:25–6:49

Regarding antibiotics, precaution should be taken during pregnancy and breastfeeding. Now, clarithromycin is contraindicated in clients with a history of hypersensitivity to other macrolides; and should be used with caution in elderly clients, or those with cardiac, hepatic, or renal disease.
On the other hand, metronidazole should be used with caution in clients with fungal infections, as well as in clients with bone marrow suppression.
Caution should also be taken in clients with dental or gastrointestinal disease, and in those with cardiac failure, hepatic, or renal disease.
And clients must not drink alcohol while taking metronidazole, as they may experience headaches, skin flushing, tachycardia, severe nausea, and vomiting.
Next, amoxicillin is contraindicated in clients with a history of hypersensitivity to other penicillins, and should be used cautiously in those with hypersensitivity to other beta lactam antibiotics like cephalosporins or carbapenems.
Lastly, tetracycline is contraindicated in children under eight years of age. Finally, bismuth subsalicylate should be avoided in children recovering from a viral infection, and should be used with caution in adult clients taking aspirin.Now, before administering treatment for H.

Nursing considerations & Client education6:49–8:54

pylori, be sure to obtain a baseline assessment of your client, including vital signs, neurological status, respiratory status, and gastrointestinal symptoms like abdominal pain and bloating.
Then, review any recent diagnostic information, including CBC, renal and hepatic function, electrolytes, and vitamin B12.
If your client is diagnosed with an ulcer, also review their radiologic or endoscopic results. Then, explain to your client why the medications are prescribed, review the prescribed length of treatment, and let your client know about some of the common side effects they may experience.
In addition, explain how the treatment can help decrease their symptoms, and prompt them to notify their healthcare provider if their symptoms don’t resolve within 7 to 14 days.
Next, teach your client to take their oral proton pump inhibitors before meals, while the timing for antibiotic administration with relation to meals is not important.
In addition, remind them to increase their dietary intake of vitamin B12 during treatment, and remind them to avoid smoking, alcohol, aspirin or other NSAIDs, caffeine, and spicy foods that may irritate the gastrointestinal tract.
Also, advise your client to notify their healthcare provider right away if they experience fever, abdominal pain, or blood in their stool; as well as other warning symptoms like confusion or hallucinations.
When bismuth subsalicylate is prescribed as part of the treatment regimen, let them know that it may cause their stools to turn black, and their tongue may become dark; and reassure them that these should resolve after treatment.
Also caution against using other salicylates, like aspirin, when taking bismuth subsalicylate. Finally, while caring for clients taking treatment for H.pylori, monitor them for side effects or therapeutic outcomes of the medications, and report any changes in the client’s condition to the healthcare provider.
Alright, as a quick recap … 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.

Review8:54–9:53

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.
Now, when caring for a client prescribed treatment for H. pylori, nursing considerations consist of obtaining baseline assessment and the client’s recent diagnostic information, as well as monitoring for side effects or therapeutic outcomes.
Client- teaching includes proper administration and length of treatment, as well as potential side effects, recommended dietary changes, and when to contact their healthcare provider.
Treatment for Helicobacter pylori: Video, Causes | Osmosis