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chu-aquitaine.fr
The recommended treatment of Helicobacter pylori infection is a seven-day course of the following regimen: a double dose proton-pump inhibitor (omeprazole 2 x 20 mg, or lansoprazole 2 x 30 mg, or pantoprazole 2 x 40 mg), associated with 2 antibiotics (amoxicillin 2 x 1,000 mg, clarithromycin 2 x 500 mg). Eradication rate is around 65%. Main causes of failure are antibiotic resistance, bad compliance, early termination of therapy due to adverse events. A second line treatment is possible with substitution of clarithromycine by metronidazole (3 x 500 mg), a longer duration of treatment (14 days) and sometimes a quadritherapy with bismuth (not available in France).
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11019637&dopt=Abstract
Z Gastroenterol. 2001 Apr;39(4):279-81, 284-5.
4-day triple therapy with rabeprazole, amoxicillin and clarithromycin in the eradication of Helicobacter pylori in patients with peptic ulcer disease--A pilot study.
Luth S, Teyssen S, Kolbel CB, Singer MV.
Department of Medicine IV (Gastroenterology/Hepatology), University Hospital of Heidelberg at Mannheim.
BACKGROUND: It is well established that a 7-day triple therapy achieves eradication rates of Helicobacter pylori between 90% and 95%. Due to a lack of highly effective short-term eradication studies the aim of the present pilot study was to investigate the effect of a 4-day triple therapy with the new proton pump inhibitor rabeprazole (20 mg b. i. d.) in combination with clarithromycin (500 mg b. i. d.) and amoxicillin (1 g b. i. d.) without acid-suppressive pre-treatment in patients with H. pylori-related peptic ulcer disease. METHODS: 20 patients (11 men, 9 women) with endoscopically diagnosed peptic ulcers (gastric ulcer: n = 5; duodenal ulcer: n = 9; combined gastric and duodenal ulcer: n = 2, gastric or duodenal ulcer scars: n = 4) and H. pylori infection were consecutively recruited. The Helicobacter pylori status was assessed by means of histology, CLO (urea-) test and C13-urea breath test (C13-UBT) at entry. Treatment success was determined by C13-UBT 35-42 days after end of treatment. RESULTS: In 18 out of the 20 patients (90%) [77-100%, 95%-CI] a negative test result was found in C13-UBT 35-42 days after treatment. The 2 patients who remained H. pylori-positive had a duodenal ulcer. CONCLUSION: A 4-day triple therapy of rabeprazole in combination with clarithromycin and amoxicillin seems to be highly effective in eradicating H. pylori and well tolerated in patients with gastric and duodenal ulcer disease. The achieved eradication rate of 90% is comparable with the established 7-day triple therapy regimens. On the basis of these results and considering costs, side effects and compliance a large number of patients should be enrolled in a confirmatory 4-day eradication trial.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11367976&dopt=Abstract
fop.unicamp.br
Few reports are available about tissue concentration of amoxicillin. The techniques used to measure tissue concentration usually require rupture and are expensive. The objective of the present study is to assess the utility of an animal model to predict tissue concentration of amoxicillin using induced granulomatous tissue. We used 160 rats with four polyurethane sponges previously implanted in their backs. At 7, 14, 21 and 28 d after sponge introduction, groups of eight animals each received 3.5, 7.0, 40.0 or 80.0 mg/kg of amoxicillin (p.o.) or 1 ml of 0.9% NaCl solution (control group). One hour after drug administration, 10 microl of serum and granulomatous tissue were obtained. Tissue and serum were placed on different plates containing Mueller Hinton agar inoculated with 10(8) cfu (colony forming unit) of Staphylococcus aureus (ATCC 25923), and the diameters of the inhibition zones were measured after 18 h of incubation. Analysis of variance showed no statistically significant differences (p>0.05) among time periods for the same dose of amoxicillin. These results suggest that the pharmacokinetics of amoxicillin did not change in relation to the development of granulomatous tissue; therefore this method is valid to measure the tissue concentration of amoxicillin.
online pharmacy ref source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=10993199&dopt=Abstract
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