Treatment of gastritis with antibiotics: a scheme, how to take

If the pathogenesis of inflammation of the mucous membrane lining the stomach cavity is associated with a bacterial infection, antibiotics should be used for gastritis. Then treatment will eliminate not only its symptoms, but also the cause.

Indications of the antibiotics for gastritis

Treatment of gastritis depends on the cause of the disease, and antibiotics for gastritis are used in cases when the presence of an infectious agent has been detected during the examination.

Antibiotics are used in acute gastritis of toxic-infectious etiology, which can accompany dysentery, pneumonia, hepatitis, measles or influenza, as well as endogenous intoxications. For example, acute infectious gastritis can be the result of infection with salmonella (salmonella gastritis), which got into the stomach with poor-quality food. For such inflammations of the stomach is characterized by the development of gastroenterocolitis, requiring the use of antimicrobial agents.

Since in 9 cases out of 10 the cause of inflammation of the gastric mucosa is its infection with a spiraling Gram-negative bacterium Helicobacter pylori, then antibiotics are used in erosive gastritis, with gastritis with high acidity, with gastritis with reduced acidity. Also, in the presence of this bacterium for etiotropic treatment, antibiotics are used for chronic gastritis, regardless of the pH of the gastric juice.

[1], [2], [5]

Release form

The gastritis and gastric ulcer caused by H. Pylori are treated with antibiotics, and in gastroenterology there is a standard of treatment aimed at eradication (ie, destruction) of this pathogen. Names of antibiotics for gastritis associated with Helicobacter pylori infection:

• Clarithromycin (other trade names: Clacid, Claricid, Klabaks, Clamed, Aziklar, Romiklar, Fromilid, etc.) is a semisynthetic antibiotic of the macrolide group. Form release: tablets of 250 and 500 mg.
• Amoxicillin (synonyms: Amoxyl, Amoxylate, Danemox, Dedoxil, Flemoxin solutab) is a synthetic penicillin antibiotic. Form release: coated tablets of 1 g; tablets are soluble; capsules of 250 and 500 mg each; granules (for the preparation of the ingested suspension).

These drugs have been selected in numerous clinical trials that have identified and confirmed their resistance to acid in the stomach, the maximum efficacy and the minimal side effect of all antibacterial agents.

It should be noted that in addition to antibiotics in the eradication drug therapy H. Pylori used drugs that block the production of hydrochloric acid in the stomach, enhance the effect of antibiotics and promote the healing of damaged mucosa. Reduce the production of acid antisecretory drugs - inhibitors of the proton pump (enzyme H ⁺ / K ⁺ -ATPase): Omeprazole (Omega, Omitox, Gastrozol, Ultop and other trade names). But they are contraindicated when antibiotics are used for gastritis with low acidity.

The scheme for the destruction of Helicobacter infection also uses the preparation of bismuth De-Nol and antibiotics for gastritis. Containing sub citrate or tricium bismuth dicitrate, gastroprotectors (enveloping agents) - De-Nol (Gastro-norms, Bismofalk), Ventrisol (Vitrinol) - not only form a protective film on the gastric mucosa, but also have bactericidal properties. These properties are manifested in the suppression of the bacterial motility and the ability of the proteins of its outer shell to adhere to the epitheliocytes of the gastric mucosa.

[6], [9], [10]

Pharmacodynamics

Being a semisynthetic derivative of erythromycin (6-O-methylerythromycin), Clarithromycin binds to bacterial ribosomes (with 50-S subunits of organoide membranes) and stops the process of biosynthesis of their proteins, which leads to the death of microorganisms.

Pharmacodynamics Amoxicillin, as an ampicillin derivative, is due to the inhibition of enzymes (transpeptidase and carboxypeptidase) of bacteria that crosslink amino acid components into the peptidoglycans of the walls of the microorganism. Thus, the decomposition of peptidoglycans occurs, the division and growth of bacterial cells ceases, and they die by lysis.

[11], [12]

Pharmacokinetics

After ingestion, Clarithromycin is rapidly absorbed into the digestive tract and enters the systemic circulation; the highest plasma concentration in the plasma is observed on average 2.5 hours after application. Biological availability is about 50%.

In the liver, approximately 20% of the dose of Clarithromycin undergoes oxidation with the formation of a bactericidal active metabolite - 14-OH-clarithromycin. The drug is split in the liver; biotransformation products are excreted from the body by the intestine (more than half) and by the kidneys.

Pharmacokinetics of Amoxicillin has a higher bioavailability of the drug, which reaches 95%, and the maximum concentration in the blood plasma is observed 90 minutes after administration, although the level of binding to plasma proteins does not exceed 20%. Amoxicillin is metabolized in the liver, metabolites are inactive. Elimination of almost two thirds of the cleavage products is carried out by the kidneys with a half-life period of 1-1.5 hours.

[14], [15]

Dosing and administration

According to the first scheme of eradication of Helicobacter pylori, a single dose of Clarithromycin is 500 mg, the drug is taken twice a day (1 g in total).

Amoxicillin is also taken twice a day - 1 g. In addition, it is supposed to take the drug Omeprazole (proton pump inhibitor) - 2-4 capsules (0.02 g) twice a day. The course of treatment usually lasts 10 days.

According to the second scheme, De-Nol and antibiotics for gastritis are taken: Clarithromycin and Amoxicillin - in the same dosage; De-Nol - half an hour before meals, one tablet (120 mg) twice a day. Duration of application - 7-14 days.

[28], [31], [32]

Use of the antibiotics for gastritis during pregnancy

Clarithromycin has a category C action on the fetus (according to the FDA), it is forbidden to use it in the first three months of pregnancy, including, and for the treatment of gastritis.

The use of antibiotic Amoxicillin during gastritis during pregnancy requires caution and is permissible only in extreme cases.

Contraindications

Contraindications Clarithromycin include:

• children under 12 years (for tablets);
• severe liver and / or kidney failure;
• the presence in the anamnesis of lengthening the interval of QT or ventricular cardiac arrhythmia;
• hypoglycemia.

According to the instructions, Amoxicillin is contraindicated when:

• hypersensitivity to antibiotics of the penicillin group;
• infectious mononucleosis;
• lymphocytic leukemia;
• tendency to bleeding;
• functional liver failure;
• salmonella gastritis and shigellosis.

Amoxicillin is not used in the treatment of children under 10 years of age.

[18], [19], [20]

Side effects of the antibiotics for gastritis

Clarithromycin can cause such side effects: nausea, vomiting, taste change and diarrhea; headache and abdominal pain; increased blood glucose levels; mycosis of the oral mucosa; urticaria; dizziness, sleep disturbance, tachycardia; the possibility of developing an anaphylactic shock is not ruled out.

Among the side effects of Amoxicillin are allergic reactions, and with a decrease in immunity, the development of superinfections.

[22], [24], [25], [26]

Overdose

In cases of overdose of these antibacterial drugs, there is an increase in side effects; it is recommended to carry out usual gastric lavage.

[35], [38], [39]

Interactions with other drugs

The simultaneous use of Clarithromycin with anticonvulsants, bronchodilators, H1-histamine receptor blocking drugs, tranquilizers-benzodiazepines, ergot-based drugs enhances their effect.

Clarithromycin should not be taken concurrently with cardiotonics - cardiac glycosides and antiarrhythmics containing quinidine. It should be borne in mind that this antibiotic potentiates the effect of indirect anticoagulants (for example, warfarin).

Joint use of Amoxicillin with antibiotics of the aminoglycoside group and laxatives reduces its absorption in the gastrointestinal tract, and ascorbic acid increases.

[41], [44]

Storage conditions

Antibiotics for gastritis - Clarithromycin and Amoxicillin should be stored in a dark place at a temperature of no higher than + 25 ° C.

[45], [46], [47], [48], [50], [51], [52]

Shelf life

The shelf life of both drugs is 24 months.

[53], [57], [58], [60], [61], [62]