anti Hpylori drugs

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Slide 1 :

Anti-H. pylori drugs -shrey bhatia

Slide 2 :

HELICOBACTER PYLORI Previously named Campylobacter pyloridis, is a Gram-negative, microaerophilic bacterium found in the stomach. In 1982 Barry Marshall and Robin Warren, found that it was present in patients with chronic gastritis and gastric ulcers

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MORPHOLOGY helix-shaped (curved rod, not spirochaete), About 3 micrometres long, diameter-0.5 micrometres. Microaerophilic; requires oxygen, It contains a hydrogenase which can be used to obtain energy by oxidizing molecular hydrogen (H2) produced by intestinal bacteria It produces oxidase, catalase, and urease. It is capable of forming biofilms and can convert from spiral to a coccoid form Scanning electron micrograph of H. pylori

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PATHOPHYSIOLOGY OF H.pylori INFECTION H. pylori survives the acidic pH of the stomach lumen Uses its flagella to burrow into the mucus of stomach to reach its microenvironment, close to the stomach's epithelial cell layer H. pylori senses the pH gradient within the mucus layer by chemotaxis

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CONTINUED It swims towards the more neutral pH environment of epithelial cell surface. H. pylori produces large amounts of the enzyme urease, Urease breaks down urea (which is normally secreted into the stomach) to carbon dioxide and ammonia. The ammonia is converted to ammonium by accepting a proton (H+), which neutralizes gastric acid.

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CONTINUED Colonization of the stomach by H. pylori results in chronic gastritis The inflammatory response to the bacteria induces G cells in the antrum to secrete the hormone gastrin, Gastrin stimulates the parietal cells to secrete even more acid The number of parietal cells to also increase, further escalating the amount of acid secreted. The increased acid load damages the duodenum, and ulceration may eventually result

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LABORATORY DIAGNOSIS Blood antibody test Stool antigen test Carbon urea breath test (in which the patient drinks 14C- or 13C-labelled urea, which the bacterium metabolizes, producing labelled carbon dioxide that can be detected in the breath)

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continued Rapid urease test: A biopsy of mucosa is taken from the antrum, and is placed into a medium containing urea and an indicator such as phenol red. The urease produced by H. pylori hydrolyzes urea to ammonia, which raises the pH of the medium, and changes the color of the specimen from yellow (NEGATIVE) to red (POSITIVE) Histological examination, Microbial culture. Urine ELISA

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TREATMENT The normal procedure is to eradicate H.pylori and allow the ulcer to heal First line treatment consists of one standard dose of proton pump inhibitor and two antibiotics 7-14days This is called ‘tripple theray’ Second line treatment done for Individuals harbouring antibiotic-resistant bacteria, require alternative strategies, such as a ‘quadruple therapy’, which adds a bismuth colloid

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FIRST AND SECOND LINE THERAPIES First and second line therapies 7 days PPI standard dose bd*/clarithromycin 500 mg bd/metronidazole 500 mg bd 14 days PPI standard dose bd*/colloidal bismuth subcitrate 120 mg qid**/tetracycline 500 mg qid**#/metronidazole 400 mg qid 10 days 5 days of PPI standard dose bd*/amoxicillin 1000 mg bd followed by 5 days of PPI standard dose bd*/clarithromycin 500 mg bd/ tinidazole 500 mg bd Third line (‘rescue/salvage’) therapies 14 days PPI standard dose bd*/bismuth subcitrate 120 mg qid**/furazolidone 200 mg bd**/tetracycline 500 mg qid**# 14 days PPI standard dose bd*/amoxicillin 1000 mg bd/rifabutin 150 mg bd/ciprofloxacin 500 mg bd * Standard PPI doses: esomeprazole 40 mg/day, lansoprazole 30 mg/day, omeraprazole 20 mg/day, pantoprazole 40 mg/day, rabeprazole 20 mg/day ** Available from supplier once TGA-SAS approval is obtained (see Table 5) # Tetracycline cannot be replaced with doxycycline because of different pharmacokinetics bd = twice daily, qid = 4 times daily * Standard PPI doses: esomeprazole 40 mg/day, lansoprazole 30 mg/day, omeraprazole 20 mg/day, pantoprazole 40 mg/day, rabeprazole 20 mg/day

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THIRD LINE THERAPIES * Standard PPI doses: esomeprazole 40 mg/day, lansoprazole 30 mg/day, omeraprazole 20 mg/day, pantoprazole 40 mg/day, rabeprazole 20 mg/day

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After complition of triple therapy, ppi should be continued once daily for 4-6 weeks to ensure complete ulcer healing Amoxicillin could be replaced with metronidazole for people who are allergic to penicillin Bismuth compounds have direct antimicrobial activity against H.pylori. Examples- bismuth subsalicylate, bismuth subcitrate potassium

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SIDE EFFECTS OF TREATMENT

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	shrey.bhatia@ymail.com 11 Months ago.



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