Peptic Ulcers - Treatment for NSAID-Induced Ulcers

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Antibiotics

H. pylori may be treated with the following antibiotics:

• Amoxicillin is a form of penicillin. It is very effective against H. pylori and is inexpensive, but some people are allergic to it.
• Clarithromycin (Biaxin) is part of the macrolide class of antibiotics. It is the most expensive antibiotic used against H. pylori. It is very effective, but there is growing bacterial resistance to this drug. Resistance rates tend to be higher in women and increase with age. Researchers fear that resistance will increase as more people use the drug.
• Tetracycline is effective, but this medicine has unique side effects, including tooth discoloration in children. Pregnant women cannot take tetracycline.
• Ciprofloxacin (Cipro), a fluoroquinolone, is also sometimes used in ulcer regimens.
• Metronidazole (Flagyl) was the mainstay in initial combination regimens for H. pylori. As with clarithromycin, however, there continues to be growing bacterial resistance to the drug.

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Side Effects of Antibiotics.

• The most common side effects of nearly all antibiotics are gastrointestinal problems such as cramps, nausea, vomiting, and diarrhea.
• Allergic reactions can also occur with all antibiotics, but are most common with medications derived from penicillin or sulfa. These reactions can range from mild skin rashes to rare, but severe and even life-threatening anaphylactic shock.
• Some drugs, including certain over-the-counter medications, interact with antibiotics. Patients should report all medications they are taking to their doctor.
• Antibiotics double the risk of vaginal yeast infections.

Bismuth

Compounds that contain bismuth destroy the cell walls of H. pylori bacteria. The only bismuth compound available in the U.S. has been bismuth subsalicylate (Pepto-Bismol), although a combination of the H2 blocker ranitidine and bismuth citrate (Tritec) has been released. High doses of bismuth can cause vomiting and depression of the central nervous system, but the doses given for ulcer patients rarely cause side effects.

Proton Pump Inhibitors (PPIs)

Actions against ulcers. PPIs are the drugs of choice for managing patients with peptic ulcers, regardless of the cause. They suppress the production of stomach acid by blocking the gastric acid pump -- the molecule in the stomach glands that is responsible for acid secretion.

PPIs can be used either as part of a multidrug regimen for H. pylori, or alone for preventing and healing NSAID-caused ulcers. They are also useful for treating ulcers caused by Zollinger-Ellison syndrome. They are considered to be more effective than H2 blockers.