The 13 best drugs to treat Helicobacter infection (Helicobacter pylori)

*A review of the best according to the editorial board. About the selection criteria. This material is subjective, not an advertisement and does not serve as a guide to purchase. It is necessary to consult with a specialist before purchase.

After reading this article, a person without a medical education can not only understand what is a Helicobacter infection, but more importantly – why it should be treated, and how it should be treated according to modern concepts. So if a doctor just suggests you “take an antibiotic” to get rid of Helicobacter pylori, then after reading this article, of course, you will run away from such a doctor like the plague, and look for a real specialist. Helicobacter infection treatment is not an easy thing, but first things first.

At first it seemed unbelievable that in the acidic environment of the stomach, which can dissolve even iron filings, a microorganism could live and multiply. Then it became a proven fact. It is a delicate, spiral wrapped microorganism – Helicobacter pylori. At first they were thought to be an accidental finding, then they were considered harmless saprophytes. But then these germs became increasingly common in patients with abdominal pain, with belching, heartburn and other symptoms of upper, or gastric dyspepsia.

But the importance of this infectious agent increased many times over when a close relationship was established between the presence of Helicobacter and the development of peptic ulcer disease and malignant neoplasms of this organ in carriers of Helicobacter. Oncology specialists consider the presence of Helicobacter infection as a pronounced level 1 carcinogen.

It is important that identifying the presence of this infection is now very easy. There is a special urease breath test. This is a very effective and non-invasive way, all it takes is “breathing into a tube”. Anyone can do this test and find out if a person is at risk.

But unfortunately “our people” don’t pay much attention to prevention, and often they end up at the operating table already with complications – for example, with a stomach ulcer. Therefore if the person is elder than 50-55 years old, if he has already revealed the symptoms of dyspeptic disorders, and the doctor has “suspicion on cancer”, (for example, there is loss of weight, appetite, the presence of symptoms of iron deficiency anemia), then already need to do gastroendoscopy with biopsy.

Proven by, that the presence of a long-standing Helicobacter infection can cause not only gastric and duodenal ulcer, but also gastric cancer. Helicobacter infection can cause iron deficiency anemia, plasma platelet counts drop, cause chronic vitamin B12 deficiency, which manifests as neurologic disorders.

Therefore, the treatment of Helicobacter infection is important, although not easy. The very procedure of destroying this microorganism is called eradication, which is Latin for “eradication”. It’s not a coincidental term. Simply by prescribing any one drug, “on the off chance” to destroy a Helicobacter infection, for which the harsh conditions of gastric juice are the norm, is impossible. There are many eradication regimens that are all recognized, “work,” and are used for one indication or another. But before proceeding to medication, it is necessary to accurately determine the indications for treatment.

Who is shown treatment?

In the modern world, in countries with a high level of medicine, there is a preventive focus of treatment. This means that it is better to avoid a condition altogether, than to treat a developed disease later on at great expense. Therefore, if a person who does not have any complaints, independently decides to be examined for Helicobacter infection and it is confirmed, it is possible to carry out treatment with a preventive purpose to reduce the risk of developing serious diseases later.

If the patient already has any symptoms, then the treatment is all the more indicated, and in the first place, with such conditions as:

1. The presence of pronounced symptoms of dyspepsia, such as heartburn, nausea, bloating, and heaviness in the stomach after eating;
2. blunt, non-localized, wandering pain or discomfort in the epigastrium;
3. nausea and bitterness in the mouth;
4. presence of diagnosed peptic ulcer disease of the stomach and or duodenum on the background of the identified Helicobacter infection;
5. special lymphoma, or tumor associated with the gastric mucosa, the so-called MALT – lymphoma;
6. Helicobacter infection is known to increase the risk of erosive gastritis and peptic ulcer disease when taking nonsteroidal anti-inflammatory drugs, such as aspirin, and especially indomethacin and diclofenac for a long time. Therefore, if a patient is proven to have a Helicobacter infection and is preparing to receive long-term non-steroidal anti-inflammatory drugs, such as when diagnosed with rheumatoid arthritis, then preventive treatment is also necessary;
7. in the presence of proven intestinal metaplasia, or epithelial atrophy, detected by gastroduodenoscopy;
8. if a patient who is a carrier of Helicobacter infection has immediate family members – parents, or siblings – who have been diagnosed with gastric cancer or have a family history of death from the disease;
9. in the presence of iron deficiency anemia of unclear etiology, if other causes are excluded, as well as in idiopathic thrombocytopenic purpura;
10. Another indication for prescribing an eradication regimen is a diagnosis of Menetries disease, or hypertrophic gastritis. In this disease, the mucous membrane of the stomach enlarges, forms folds, and cystic growths and various adenomas develop in it. Menetries disease is known to be considered an elective (optional) precancerous condition.

Modern gastroenterology does not stand still, and the best eradication schemes are constantly being selected. After all, this microorganism, as well as all other microbes responsible for the development of certain diseases, is constantly improving, and resistance, that is, resistance of Helicobacter to antibiotics is gradually increasing. Therefore, the basis of this article will be the so-called “Maastricht Consensus V” of 2015.

According to this authoritative meeting of gastroenterologists, the results of which are accepted for action in many countries, including the Russian Federation, and recommended by the World Health Organization (WHO), timely treatment of Helicobacter infection, or eradication:

1. Reduces the risk of gastric malignancies by almost 35%;
2. already diagnosed precancerous gastric disease has stopped progressing;
3. if gastroscopy has revealed gastric atrophy, this atrophy disappears, and the gastric mucosa is restored;

Finally, timely eradication of Helicobacter infection is economically profitable for the patient and the doctor, because the cost is extremely low in comparison with the cost of treatment of an advanced case of stomach ulcer or cancer, which are the cause of this infection.

Overview of medications to treat Helicobacter pylori infection

The main medicines for eradication

First we list the main groups of medications that are used according to a certain regimen for the eradication of Helicobacter infection. After reading this review, the patient will roughly understand from which means the treating gastroenterologist will choose. All of the drugs listed below are pills or capsules, and no injections, drips or other forms of parenteral administration are used to treat a Helicobacter infection. Either plain tablets, film-coated tablets or enteric capsules are sufficient.

All drugs listed are registered in the territory of the Russian Federation. First, the list contains the international nonproprietary name (INN), followed by a list of synonyms of various drugs with the same active substance, which are manufactured by different companies. As a rule, the most expensive preparation is the original one, which means that it was developed for the first time and is the most reliable and uses the purest substance. As you know, treating with the original medicine is always better for your health, but it may not be good for your pocket. Of course, there are also quality generics, which, although not produced by the company that produced the original drug, but by reliable manufacturing companies with a good reputation and good quality of pharmaceutical substances.

Also listed is the minimum cost, as well as the price spread. The cost of the remedy, which is prescribed for eradication, is given with the required amount of the medicine. List prices are current for pharmacies of various forms of ownership in the Russian Federation for fall 2019.

After the list of medicines the different regimens are explained directly, so you should not try to make up your own eradication schemes with the following medicines or use any single medicine. This is a gross mistake and is nothing more than self-medication.

PPIs – proton pump inhibitors

Proton pump inhibitors reduce the acidity of gastric juice, and treat symptoms such as heartburn. There are several generations of these medicines and the further down the list the medicines in this group are, the more modern and effective they are.

The history of proton pump inhibitors began with omeprazole, which was first created in Sweden in 1979 under the name. It began to be sold in 1988, as various clinical trials took place over the course of 9 years, and immediately created a furor. With the introduction of this medication, the era of remedies that were able to proven to control the concentration of gastric juice acid began. The use of antisecretory drugs in the therapy of gastritis and peptic ulcer disease, described below, eventually led to a reduction in the number of surgical interventions for ulcers, and made possible, with early diagnosis, conservative treatment of this severe disease. All of the following medicines are used in different eradication regimens.

It should be noted that the drug of the latest generation of PPIs registered in Russia (Dexilant) is not yet used in eradication therapy regimens. It treats erosive esophagitis, as well as gastroesophageal reflux disease. Therefore, it should not be assumed that the most medication will be the best. Therefore it is necessary to obey the instructions of the treating doctor and if you buy one package of Dexilant for “self-made” eradication, you will just waste 2000 rubles.

Omeprazole (Gastrozole, Omez, Ortanol, Ultop)

Popularity Rating:* 4.9

Omeprazole belongs to the first generation of proton pump inhibitors, and it is successfully used in eradication therapy schemes, especially in their “budget” variant. Omeprazole is available in 20 mg capsules and has the effect of decreasing the activity of hydrogen-potassium ATPase, an enzyme involved in the synthesis of hydrochloric acid. As a result, the acidity of gastric juice decreases.

Omeprazole is very fast-acting and reaches its maximum effect after 2 hours. The action of the drug gradually decreases, but even after 24 hours after taking a single dose, hydrochloric acid does not reach 50% of its normal concentration, that is, there is reliable inhibition of half of the secretion. Omeprazole is usually taken once a day, but in the eradication schemes – twice a day, and the maximum effect due to the accumulation of the drug is observed after about 4-5 days. The drug is completely transformed in the liver by the cytochrome system, and is excreted by the kidneys.

This drug is contraindicated in children, pregnant women and during breastfeeding, with caution is used in hepatic and renal failure. Of the side effects, the most common are hives, sometimes diarrhea or constipation. Also, in no more than 1% of cases there may be abdominal pain, flatulence, nausea episodes. All other side effects are very rare, such as joint pain, dry mouth, or decreased peripheral blood leukocytes.

It is necessary to apply Omeprazole according to the scheme advised by the doctor – gastroenterologist, but usually it is received twice a day in a dose of 20 mg for one or two weeks, and necessarily in combination with other medicines. Omeprazole alone, as well as any other proton pump inhibitor, even the most advanced, cannot cope with Helicobacter infection. Importantly, Omeprazole can be taken with food without affecting the quality of treatment.

The best known drug in this group is Omez, which is produced by the Indian laboratory Dr. Reddis. The cost of one pack of 30 omeprazole capsules of 20 mg each will cost from 130 to 167 rubles. It’s an inexpensive drug.

Pantoprazole (Nolpaza)

Popularity Rating:* 4.8

Nolpaza is a second-generation remedy, pantoprazole. The tablet contains 22 mg and acts on the same enzyme, potassium hydrogen ATPase. Pantoprazole is just as quickly absorbed, and eating does not affect the quality of treatment. Like omeprazole it is metabolized in the liver and excreted through the kidneys. Unlike omeprazole, it can be used in patients with chronic renal failure, and even in those on hemodialysis. Pantoprazole can also be used in patients with cirrhosis, which is not often.

The drug is available in tablets that dissolve in the intestine and is used in eradication regimens in combination with two antibiotics. Similar to omeprazole, contraindications include pregnancy, lactation and childhood under 18 years of age, due to the small amount of accumulated data.

Of the adverse reactions, diarrhea and headache are the most common, occurring in less than 1% of patients. Other side effects include sleep disturbance, bloating and dry mouth, flatulence and constipation, and increased liver transaminases. Skin rash may occur. If Nolpaza or other pantoprazole analogues are given to a patient with HIV infection, on a background of atazanavir, this treatment should be corrected. For the eradication scheme, the drug is used the same way as Omeprazole, one tablet of 40 mg 2 times a day, the course of treatment – also from 1 to 2 weeks.

Nolpase is manufactured by Krka. One pack of the drug, designed for two weeks of treatment according to the eradication schemes, i.e. 28 tablets of 40 mg each, can be purchased in pharmacies from 370 to 430 rubles. Indian drug Panum, produced by Unic, is even cheaper – its price varies from 230 to 417 rubles. At the same dose.

Lansoprazole (Gelikol, Ranzap, Lanzoptol, Lancid, Epicur)

Popularity Rating:* 4.7

Third-generation proton pump inhibitors, such as Epicurus and Lancid, also work with potassium sodium ATPase at the last stage of hydrochloric acid formation. As a result, both total, basal, and stimulated gastric juice secretion decreases. As with omeprazole, the effect develops gradually, and reaches a maximum on the 4th day of use. The drug also binds to plasma proteins by 98%, when passing through the liver it is transformed and excreted by the kidneys.

Just as in the previous case, the remedy is used for eradication therapy. Not to be used in children, pregnant, lactating mothers, and those with manifestations of hepatic or renal failure. Therefore, in the case of such pathology, Nolpaza will be more advantageous. Side effects include headache, dizziness drowsiness, diarrhea, skin allergic reactions, as well as rhinitis and pharyngitis.

The peculiarity of lansoprazole is the need to use the drug in the morning on an empty stomach. In the case of eradication, it is necessary to take the drug at 30 mg twice a day for up to 2 weeks, as recommended by the gastroenterologist.

The cost of the domestic drug Epicurus, just in this dosage, in the amount of 14 pieces, that is, for one week of eradication, is from 370 to 580 rubles. Accordingly, for a complete scheme, two such packages are needed. That is, you need to be guided somewhere around 1,000 rubles. The Indian drug Lancid is much cheaper. One pack of Indian lansoprazole – in a dosage of 30 mg #30, that is enough for a full two-week eradication scheme. And its price varies from 330 to 415 rbl. As a result, the drug will cost half as much.

Rabeprazole (Bereta, Pariet, Zulbecox, Rabelock, Razo, Ulcernil, Hyrabezol)

Popularity Rating:* 4.6

The 4th generation proton pump inhibitors or blockers are known to be perhaps the most expensive of this group of PPIs. It is Pariet, the original rabeprazole. It is used, of course, not only for the treatment of Helicobacter infection, but also for peptic ulcer in the acute stage, for erosive gastritis, for Zollinger-Ellison syndrome, and in other cases. It relieves heartburn and pain very well, and is considered by many to be the most effective and safest of all PPIs.

It is used under the eradication scheme of 20 mg in 2 times a day, according to the scheme prescribed by the gastroenterologist, and necessarily with the prescription of appropriate antibiotics, which will be discussed below. Importantly, the eradication regimen using Pariet, is shorter than in other cases and is only 7 days, but this still makes it the most expensive. How much will it cost to eradicate Helicobacter infection with Pariet?

A standard pack of 14 pills with the necessary concentration for this scheme will cost from 1,950 to 2,400 rubles. This drug is produced by Bushu Pharmaceuticals, and may be manufactured in Japan, Switzerland, Belgium under the patronage of Janssen Cilag, that is Johnson Johnson, Russia. Such international cooperation is not uncommon in the pharmaceutical industry.

Pariet is used in whole tablets, at any time of the day and regardless of meals, which is very convenient. As in previous cases, the drug is contraindicated in pregnancy and breastfeeding, also in children, with hypersensitivity to the active substance rabeprazole, and with caution in severe renal failure. Side effects on Pariet are mild, transient, and usually tolerated very well without any disorder. In the same case, if such effects occur, it is not more frequent than in one case per 1000 people taking Pariet. It is really very good tolerability, the drug justifies its price. If there was any disorder, it was headache, loose stools, dry mouth and constipation. Of course, if the health costs are considered excessive, you can pick up a cheaper rabeprazole. So, a drug called Razo made in India will cost only 320 to 450 rubles., There will be thirty pills in the pack, not 14.

Esomeprazole (Nexium, Emanera)

Popularity Rating:* 4.5

Nexium is the fifth generation of proton pump inhibitors, or esomeprazole. It is used in the same way as in the previous cases for eradication schemes, in a dose of 20 mg 2 times a day for 1 week. A pack of this drug intended for two eradication schemes (i.e. 28 tablets in a pack) will cost from 214 to 250 rubles., The drug is produced by Astrazeneca in Sweden. There are other analogues, such as Emanera from Slovenia, which is about the same price range.

The drug acts quickly and lasts a long time. When taken daily, the maximum development of the effect is observed on the fifth day, it has been proven that even after stimulation with pentagastrin, the acidity of the gastric juice is reduced by 90%. The effectiveness of this drug is well demonstrated by its prescription for peptic ulcer disease. After the eradication course does not require any more medications (enveloping) for subsequent healing of the ulcer, usually Nexium does well on its own.

It is also effective for bleeding from peptic. This medicine is shown for long-term use of NSAIDs, it significantly reduces the risk of stomach ulcers. The contraindications and side effects of this drug are about the same as those of previous medications, and of the side effects, headache and abdominal discomfort were most often noted.

Antimicrobials

Let’s move on to the second component of the eradication therapy schemes, which is no less important than proton pump inhibitors. Reducing gastric secretion allows “knocking the ground out from underneath” Helicobacter pylori, dramatically changing its conditions of existence, creating it discomfort. As for antibacterial drugs, they are the ones that are directly detrimental to the various life forms of Helicobacter. There is a limited number of antibacterial agents of different groups, which have been successfully approved by international community of gastroenterologists for Helicobacter infection treatment. These are the antibiotics clarithromycin and amoxicillin, metronidazole, the ancient but quite effective antibiotic tetracycline, which has also found its use, as well as a drug from the group of fluoroquinolones – levofloxacin. Let’s take a brief look at these drugs for modern eradication regimens and protocols.

Clarithromycin (Clacid, Clabax, Clabact, Ecositrin)

Popularity rating:* 4.9

Clarithromycin refers to macrolide antibiotics. The range of its use is extremely wide, we will not enumerate its effectiveness against certain microorganisms, we will only point out that Helicobacter pylori is highly sensitive to Clarithromycin. However, its sensitivity is now gradually decreasing, and treatment with clarithromycin should be given according to the patient’s area of residence. There are regions with predominantly Helicobacter infection with high resistance to clarithromycin, in which case other regimens should be used from the beginning. And there are regions in which, according to epidemiological data, Helicobacter pylori is sensitive to Clarithromycin. In the case of high sensitivity, almost 85-90% of patients will be successfully cured.

Clarithromycin is used for a week, twice a day. The usual dosage is 500 mg each. One of the most effective and highly purified drugs is the Italian Clacid. The drug is contraindicated for use in combination with ergot alkaloids for the treatment of migraine, in pregnant and lactating women, and in children under 3 years of age. In patients with serious liver dysfunction, caution should be exercised. Clacid, packed in 14 tablets of 500 mg, just for the eradication therapy scheme, costs from 650 to 850 rubles., A similar domestic drug, Ecozitrin, produced by AVVA-Rus, will cost from 370 to 420 rubles.

Perhaps the cheapest can be considered Claritrosin, made by the domestic company Synthesis, but there is a catch. A pack of 10 tablets will cost from 230 to 300 rubles., But then you’ll have to buy another pack, which is to find the missing four pills to complete the two-day regimen. As a result, you’ll spend about the same amount of money as a case of quality Italian Clacid.

Amoxicillin

Popularity rating:* 4.8

Amoxicillin is a semisynthetic penicillin that is very quickly absorbed into the blood and excreted by the kidneys. Amoxicillin in eradication therapy regimens is prescribed in high dosages: 1000 mg, i.e. 1 g twice a day. The treatment lasts for a week, which means that 14 g of amoxicillin will be needed for the course.

Perhaps the best choice can be considered the drug Flemoxin Solutab, which is available just in a dosage of 1000 mg in soluble dispersible tablets, the packaging of these tablets is 20 pieces, that is, 6 pieces will remain. The cost of this drug is from 370 to 450 rubles.,in excellent European quality. It is made by a company called Astellas in the Netherlands. The second option is Amoxicillin Sandoz, which is produced in Austria. Its quality is no worse, and the cost is much lower, from 150 to 175 rubles. The dosage is the same. The only drawback is that there are 12 pills in a pack, which means you will have to look for two more extra pills, or buy a new pack again, as with Claritrosin, so it is better to opt for Flemoxin.

Flemoxin is contraindicated in cases of sensitivity to semi-synthetic penicillins, with great caution it should be prescribed to patients who have been diagnosed with lympholeukosis, and the presence of chronic renal failure. The remedy can be used during pregnancy and lactation, but other drugs included in the eradication schemes should not be used during pregnancy. Therefore, it is better to be treated for Helicobacter infection by women at a different period of life. The drug may also cause side effects, but it is usually well tolerated. Food intake does not affect the treatment, one tablet is dissolved in a glass of water and drunk twice a day.

Tetracycline

Popularity Rating:* 4.7

Good old inexpensive tetracycline is a broad-spectrum antibiotic, and although rarely used in special eradication regimens. It is contraindicated in case of renal failure, with a significant decrease in white blood cell count, pregnancy and breastfeeding, with caution prescribed in cases of marked liver dysfunction.

Tetracycline, which is probably produced almost all in the Russian Federation, can never be adapted and packaged conveniently for eradication schemes. It should be used in high dosage, 500 mg 4 times a day, that is, 2 g daily for 10 days. Thus, the total amount of tetracycline per course will be 20 g. It comes in tablets of 100 mg, in a pack of 20 tablets. Therefore, you need 10 packs of the drug for the course of treatment, and you need to swallow 20 tablets daily, and take it often. In the morning and at lunch, in the evening and at night – five pills each time. Perhaps this is the most uncomfortable version of the drug, which can meet in the eradication scheme. Given the fact that it is produced either in Belarus, or by Tyumen chemical plant, we can not talk about European quality.

Metronidazole

Popularity Rating:* 4.6

Metronidazole for eradicating Helicobacter infection is widely used in the same way as Clarithromycin, 500 mg 2 times a day for a week. Strictly speaking, it is not an antibiotic, and affects microorganisms with its nitrogroup containing nitrogen. For example, metronidazole is produced by Takeda, and the price of the drug is very cheap. One pack of 20 pills is enough for a course of eradication, and it costs no more than 80 rubles.

Extra caution should be taken while taking metronidazole. During treatment with metronidazole it is strictly forbidden to drink alcohol, because it may cause an antabuse-like (or tetramine-like) reaction. It is associated with incomplete oxidation of alcohol and accumulation of acetic aldehyde in the blood. This leads to difficulty breathing, facial redness, toxic effects on the liver if alcohol is taken together with treatment with metronidazole.

It is contraindicated in cases of leukopenia, epilepsy and hepatic impairment, in the first trimester of pregnancy, and when breastfeeding. Against the background of taking metronidazole may be a metallic taste and dry mouth, diarrhea, dizziness, pain in the joints. In the case where the scheme of eradication together involves taking amoxicillin, and metronidazole, the patient must be over 18 years of age. Taking metronidazole may cause a reddish or brown coloring of the urine, it is a temporary phenomenon and should not be feared.

Levofloxacin (Glevo, Remedia, Tavanic)

Popularity rating:* 4.5

Finally, the fluoroquinolone levofloxacin is used in eradication regimens, and the drug Tavanic is considered one of the best representatives. It is a broad-spectrum antibacterial agent that disrupts DNA synthesis of microorganisms. Levofloxacin is effective, especially when the infection is resistant to clarithromycin. Levofloxacin is prescribed for 500 mg 2 times a day, also for a week or 10 days, at the decision of the gastroenterologist.

A pack of Tavanic for 5 days (10 pills) in the eradication scheme will cost from 670 to 900 rubles, and full treatment – 1500-2000 rubles. Tavanic is produced by the French company Sanofi. The cheapest equivalent may be Glevo from the Indian company Genmark. You can buy one 500 mg pack of 25 pills for the entire scheme for the price of 210 rubles (or less).

When prescribing Tavanic and Glevo, contraindications such as myasthenia gravis, epilepsy, age under 18 and intolerance to fluoroquinolones, pregnancy and breastfeeding should be considered. Very great caution is needed if there is a predisposition to seizures, impaired kidney function.

Combination drugs: three in one

Pilobact

Popularity Rating:* 4.9

Popularity Rating:* 4.8

To be fair, there is a combination drug called Pilobact. It was created by the enterprising Indians, Sun Pharmaceuticals. It contains clarithromycin, omeprazole and tinidazole. There is also Pilobact-AM (clarithromycin, omeprazole, and amoxicillin). Thus, a ready-made eradication regimen in “one bottle”. It is necessary to use this drug for 7 days, the remedy consists of tablets and capsules. Capsules and tablets are labeled “morning-after” and “evening-after” in separate colors, red and blue.

This drug costs about 1100 rubles. For a package of tablets and capsules, just enough for a course of therapy. However, all three substances will be of Indian quality, although they are not bad. But if a person can spend as much as needed on his treatment, of course the gastroenterologist will prescribe high quality antibiotics and proton pump blockers separately.

Bismuth preparations

Finally, the last group of drugs used for eradication are bismuth compounds. Bismuth is an element in the Mendeleev table, a metal that exhibits a number of surprising non-metallic properties. In acidic conditions of the stomach, bismuth-containing agents coat it with a protective film. Under this film, ulcers, if any, are well scarred, and the mucosa is protected from harmful factors. Under the bismuth layer, the amount of mucus increases and pepsin production decreases. Bismuth itself has antimicrobial activity deep within the mucus layer, where drugs from the blood can poorly penetrate. Importantly, bismuth preparations, if used in isolation, inhibit the activity of the microbe, but do not alter the properties of gastric juice, and do not affect digestion. However, taking bismuth compounds may stain the feces black.

These medications are on standby. They are prescribed if Helicobacter infection is highly resistant to clarithromycin. Bismuth can destroy its various forms, both coccoid and vegetative. We will not list the large number of bismuth preparations, I will only say what is used:

Bismuth subnitrate or Bismofolk;

Complex cheap “ancient” drugs Vikalin and Vikair, which are produced in Russia. These are cheap drugs, a pack of 20 tablets does not cost more than 170 rubles., But they are usually crude and not well tolerated by many;

De-Nol

Popularity Rating:* 4.9

Colloidal bismuth subcitrate in combination with potassium is considered a classic bismuth drug. It is sold under the well-known brand name De-Nol, it is manufactured in Russia under the control of Astellas. This drug is also known as Escape.

De-Nol is prescribed for adults before meals, one tablet four times a day, and at night. Other schemes are also possible. The drugs should not be taken for more than 2 months, but the eradication lasts much shorter. The cost of the drug depends on the dosage, but the average price of a pack of 32 tablets of 120 mg does not usually exceed 300 rubles.;

In international recommendations you can also find bismuth subsalicylate, a compound of the metal with salicylic acid. This compound has expressed activity against Helicobacter pylori, but in the Russian Federation it is rarely used.

Duration of bismuth compounds in eradication regimens is determined by the physician. Bismuth should not be taken during pregnancy and while breastfeeding, and should not be used for too long, because it accumulates in the central nervous system with the gradual development of symptoms of encephalopathy.

How to treat Helicobacter correctly?

Now you know what medicines are necessary to “expel” Helicobacter infection from the body. It remains to choose a therapy regimen. If it is known that in a given region of the country the level of resistance of microbes to clarithromycin is more than 15%, then alternative eradication schemes have to be used. Germs can also have resistance to metronidazole, and sometimes double resistance. But this is, of course, the complexities and subtleties, the concern of the doctor.

So there are several lines of treatment, and the first of these is universal. This line includes one of the proton pump blockers, clarithromycin, amoxicillin, or metronidazole. Standard treatment duration is a week, but if you increase it to 2 weeks, then its effectiveness increases.

The next line also includes a proton pump inhibitor, metronidazole and tetracycline, but then the bismuth drug is also added at a dose of 120 mg 4 times a day. The four component regimen (quadruple regimen) lasts for 10 days. As mentioned above, bismuth salts are prescribed if the resistance of Helicobacter infection is quite high, which is why clarithromycin is not included here.

Here is an alternative protocol called “sequential therapy”. In the beginning, the patient takes a proton pump inhibitor such as omeprazole and amoxicillin for 5 days, and then the first regimen continues for 5 days: omeprazole continues, and clarithromycin and metronidazole are added, with amoxicillin cancelled. If the region of residence is characterized by a high degree of resistance to clarithromycin, then levofloxacin is added to the eradication scheme instead.

Gastroenterologists and epidemiologists kept “racking their brains”: how to destroy such a small but so persistent Helicobacter pylori. Next, the so-called concomitant therapy was developed, and then the combination of the two types: sequential and concomitant. In the first case, the patient is prescribed a proton pump inhibitor, clarithromycin, amoxicillin and metronidazole for 10 days.

In the case of combining sequential and concomitant therapy, the patient takes a proton pump inhibitor and amoxicillin for a week, and then adds metronidazole and clarithromycin with certain subtleties. This is a fairly highly effective tactic, up to 99% cure rate, and even dual-resistant Helicobacter strains were killed.

How to enhance the treatment regimen?

Continuing to fight against Helicobacter infection, other medications are also used. There are regimens with rifabutin antibiotic (2500 rubles).) and furazolidone. High-dose two-component therapy is used, and other regimens.

In addition to bismuth drugs, it is shown in complicated cases, the use of the gastroprotector rebapimide (Rebagit). Its inclusion in the eradication regimens allows increasing the effectiveness of treatment by 12%. Also increases the effectiveness of treatment by adding probiotics, bifidobacteria and lactobacilli.

It is very important to use only internationally accepted treatment protocols, internationally approved dosages, and it is important to use only the original medications. Of course, generics seem to be effective, but the range of this effectiveness is very large – from decent to complete adulteration. Unfortunately, we are not talking about simultaneous pharmaceutical, therapeutic and biological equivalence with the original drug. Only “bioequivalence” is compared. Therefore, if the patient has no possibility to buy really working drugs, but has to be limited to the cheapest generics, then in the end Helicobacter infection will not be destroyed either. The microorganism, eventually, in this patient will have already been trained to resist the weak and low-quality drugs, acquiring additional resistance.

In conclusion, it should be cautioned that, despite the full treatment, it is possible to get a Helicobacter infection again. Unfortunately, a real vaccine against Helicobacter pylori has not yet been invented. And existing and widely advertised nutritional supplements in the form of Helinorm, which contains “special lactobacilli” have no proven efficacy. Helinorm is produced under the auspices of Nizhpharm, but it is a common dietary supplement. However, this does not prevent the manufacturer from asking from 1400 to 1900 rubles for a pack of 28 capsules. It is not part of any eradication regimen and its name hardly appears in any of the recent guidelines on the treatment of this infection.

*Popularity rating is based on the analysis of demand data from wordstat..