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Only for medical professionals to read for reference, experts will take you out of the plight of drug resistance! When treating Helicobacter pylori positive, do you often encounter such a problem: how to deal with drug resistance? How to standardize treatment and management of HP infection in children? The main reasons and countermeasures for HP eradication failure? In response, the medical community specially invited Professor Lin Rong from Union Hospital of Tongji Medical College of Huazhong University of Science and Technology, Professor Zhou Liya, Director of Peking University Digestive Disease Research Center, Professor Chen Ye, Deputy Director of Gastroenterology Department of Southern Hospital of Southern Medical University, and First Affiliated of Nanchang University Professor Zhu Yin, deputy director of the hospital’s gastroenterology department, and other expert teams, produced this course "Summary of Helicobacter Pylori Eradication Treatment Programs", and discussed and learned about HP eradication programs and precautions with us.
Don't miss it! 1.
Getting out of the plight of Helicobacter pylori resistance and restarting dual eradication therapy The main factors that affect the efficacy of HP eradication are as follows: (1) Host: CYP2C19 gene polymorphism, compliance, smoking, disease types
.
(2) Antibiotics: resistance to antibiotics, bacterial virulence, bacterial quantity
.
Compliance and antibiotic resistance are risk factors for HP eradication failure.
In the first-line treatment, bismuth quadruple therapy is often used as the main empirical treatment to eradicate HP
.
In recent years, the resistance rate of people to antibiotics has gradually increased, but the eradication rate has not increased.
Clinically, safer, effective and economical anti-HP programs are needed
.
The adverse effects of dual eradication therapy such as amoxicillin + esomeprazole are lower than that of bismuth quadruple therapy, and, compared with bismuth quadruple therapy, high-dose amoxicillin + esomeprazole has The economic cost is lower
.
In addition, the dual therapy is equivalent to the bismuth quadruple therapy
.
Therefore, high-dose amoxicillin + esomeprazole dual therapy can be used as a first-line treatment to eradicate HP
.
2.
Standardized management of HP infection in children There are large regional differences in HP infection rates among children worldwide.
There are obvious differences between developed and developing countries.
So, how should we conduct standardized treatment and management of HP infection in children? Figure: Distribution of HP infection in children worldwide 1.
The characteristics of HP infection in children found that the risk of serious diseases is low
.
There are many unfavorable factors in eradication treatment: the choice of antibacterial drugs is small, and the tolerance to adverse drug reactions is low
.
Children with HP infection have a certain spontaneous clearance rate
.
The reinfection rate is higher after eradication
.
2.
Detection of HP infection in children: It needs to be based on gastroscopy biopsy pathology or culture, and does not support the "detection and treatment" strategy
.
3.
Treatment of HP infection in children: based on the first choice of drug sensitivity, triple or bismuth quadruple, high-dose, full course, higher PPI dosage (1.
5~2.
5mg/kg/d), longer course (14 days)
.
4.
Emphasize the importance of compliance to successful eradication to parents and children
.
5.
Strictly grasp the indications and use PPI with caution
.
3.
The main reasons and countermeasures for HP eradication failure 1.
What are the common reasons for HP eradication failure? Bacterial causes: drug resistance, biofilm formation
.
The patient's own factors: CYP2C19 gene polymorphism, patient compliance
.
Doctor’s reasons: Irregular diagnosis and treatment, HP's resistance to antibiotics
.
2.
Key countermeasures for HP eradication failure (1) Standardize and effective eradication to increase the first eradication rate
.
Bismuth quadruple program
.
A combination of sensitive antibacterial drugs
.
Choose efficient PPI
.
Prolong the course of treatment as much as possible
.
(2) Treat remedial treatment after failure with caution
.
Find the reason for the failure
.
Whether the program selection is correct
.
HP resistance/CYP2C19/compliance
.
3.
The principle of remedial treatment selection should refer to the previously used programs
.
Do not repeat the original plan
.
Do not repeat clarithromycin or levofloxacin
.
Repeated application of metronidazole needs to optimize the dose
.
Want to know more about the joint consensus of various countries on the treatment of HP infection? Want to learn more about anti-HP infection drugs? Hurry up and start this course, let professional tutors take you out of the plight of HP infection treatment! How to get the course? Scan the QR code of the poster below to unlock for free
Don't miss it! 1.
Getting out of the plight of Helicobacter pylori resistance and restarting dual eradication therapy The main factors that affect the efficacy of HP eradication are as follows: (1) Host: CYP2C19 gene polymorphism, compliance, smoking, disease types
.
(2) Antibiotics: resistance to antibiotics, bacterial virulence, bacterial quantity
.
Compliance and antibiotic resistance are risk factors for HP eradication failure.
In the first-line treatment, bismuth quadruple therapy is often used as the main empirical treatment to eradicate HP
.
In recent years, the resistance rate of people to antibiotics has gradually increased, but the eradication rate has not increased.
Clinically, safer, effective and economical anti-HP programs are needed
.
The adverse effects of dual eradication therapy such as amoxicillin + esomeprazole are lower than that of bismuth quadruple therapy, and, compared with bismuth quadruple therapy, high-dose amoxicillin + esomeprazole has The economic cost is lower
.
In addition, the dual therapy is equivalent to the bismuth quadruple therapy
.
Therefore, high-dose amoxicillin + esomeprazole dual therapy can be used as a first-line treatment to eradicate HP
.
2.
Standardized management of HP infection in children There are large regional differences in HP infection rates among children worldwide.
There are obvious differences between developed and developing countries.
So, how should we conduct standardized treatment and management of HP infection in children? Figure: Distribution of HP infection in children worldwide 1.
The characteristics of HP infection in children found that the risk of serious diseases is low
.
There are many unfavorable factors in eradication treatment: the choice of antibacterial drugs is small, and the tolerance to adverse drug reactions is low
.
Children with HP infection have a certain spontaneous clearance rate
.
The reinfection rate is higher after eradication
.
2.
Detection of HP infection in children: It needs to be based on gastroscopy biopsy pathology or culture, and does not support the "detection and treatment" strategy
.
3.
Treatment of HP infection in children: based on the first choice of drug sensitivity, triple or bismuth quadruple, high-dose, full course, higher PPI dosage (1.
5~2.
5mg/kg/d), longer course (14 days)
.
4.
Emphasize the importance of compliance to successful eradication to parents and children
.
5.
Strictly grasp the indications and use PPI with caution
.
3.
The main reasons and countermeasures for HP eradication failure 1.
What are the common reasons for HP eradication failure? Bacterial causes: drug resistance, biofilm formation
.
The patient's own factors: CYP2C19 gene polymorphism, patient compliance
.
Doctor’s reasons: Irregular diagnosis and treatment, HP's resistance to antibiotics
.
2.
Key countermeasures for HP eradication failure (1) Standardize and effective eradication to increase the first eradication rate
.
Bismuth quadruple program
.
A combination of sensitive antibacterial drugs
.
Choose efficient PPI
.
Prolong the course of treatment as much as possible
.
(2) Treat remedial treatment after failure with caution
.
Find the reason for the failure
.
Whether the program selection is correct
.
HP resistance/CYP2C19/compliance
.
3.
The principle of remedial treatment selection should refer to the previously used programs
.
Do not repeat the original plan
.
Do not repeat clarithromycin or levofloxacin
.
Repeated application of metronidazole needs to optimize the dose
.
Want to know more about the joint consensus of various countries on the treatment of HP infection? Want to learn more about anti-HP infection drugs? Hurry up and start this course, let professional tutors take you out of the plight of HP infection treatment! How to get the course? Scan the QR code of the poster below to unlock for free