A 48-year-old woman has been diagnosed with a duodenal ulcer that is complicated by H. pylori infection. A suitable therapeutic regimen for this patient would be
a single antibiotic.
+a single antibiotic plus a proton pump inhibitor.
+misoprostol plus a proton pump inhibitor.
+an H2 receptor antagonist.
+2 antibiotics plus a proton pump inhibitor.
Answer is e. H. pylori infection is effectively eradicated with an acid-suppressing drug plus at least 2 antibiotics (see Table 32-1). A single antibiotic or acid-suppressing drug alone is not effective in eradicating H. pylori.
+| Triple therapy × 14 days: Proton pump inhibitor + clarithromycin 500 mg plus metronidazole 500 mg or amoxicillin 1 g twice a day (tetracycline 500 mg can be substituted for amoxicillin or metronidazole) Quadruple therapy × 14 days: Proton pump inhibitor twice a day + metronidazole 500 mg three times daily plus bismuth subsalicylate 525 mg + tetracycline 500 mg four times daily or H2 receptor antagonist twice a day plus bismuth subsalicylate 525 mg + metronidazole 250 mg + tetracycline 500 mg four times daily Dosages: | |
| Proton pump inhibitors: | H2 receptor antagonists: |
| Omeprazole: 20 mg | Cimetidine: 400 mg |
| Lansoprazole: 30 mg | Famotidine: 20 mg |
| Rabeprazole: 20 mg | Nizatidine: 150 mg |
| Pantoprazole: 40 mg | Ranitidine: 150 mg |
| Esomeprazole: 40 mg | |