Treatment of gastritis with antibiotics: 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 the treatment will eliminate not only its symptoms, but also the cause.

Indications antibiotics for gastritis

Treatment of gastritis depends on the cause of the disease, and antibiotics for gastritis are used in cases where the presence of an infectious agent is revealed during the examination.

Antibiotics are used for acute gastritis of toxic-infectious etiology, which may accompany dysentery, pneumonia, hepatitis, measles or flu, as well as endogenous intoxications. For example, acute infectious gastritis may be the result of salmonella infection (salmonella gastritis), which entered the stomach with poor-quality food products. Such inflammations of the stomach are characterized by the development of gastroenterocolitis, which requires the use of antimicrobial drugs.

Since in 9 cases out of 10 the cause of inflammation of the gastric mucosa is its infection with the spiral-shaped gram-negative bacterium Helicobacter pylori, antibiotics are used for erosive gastritis, gastritis with high acidity, and gastritis with low acidity. Also, in the presence of this bacterium, antibiotics are used for etiotropic treatment for chronic gastritis - regardless of the pH level of the gastric juice.

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Release form

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

• Clarithromycin (other trade names: Klacid, Claricide, Klabax, Clamed, Aziklar, Romiklar, Fromilid, etc.) is a semi-synthetic antibiotic of the macrolide group. Release form: tablets of 250 and 500 mg.
• Amoxicillin (synonyms: Amoxil, Amoxillat, Danemox, Dedoxil, Flemoxin Solutab) is a synthetic penicillin antibiotic. Release form: film-coated tablets of 1 g; soluble tablets; capsules of 250 and 500 mg; granules (for the preparation of an oral suspension).

These drugs were selected through numerous clinical studies that identified and confirmed their resistance to stomach acid, maximum effectiveness and minimal side effects, which are common to all antibacterial agents.

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

The scheme for destroying Helicobacter infection also uses the bismuth preparation De-Nol and antibiotics for gastritis. Gastroprotectors (enveloping agents) containing bismuth subcitrate or tripotassium dicitrate – De-Nol (Gastro-norm, Bismofalk), Ventrisol (Vitridinol) – not only form a protective film on the gastric mucosa, but also have bactericidal properties. These properties are manifested in the suppression of the mobility of the bacterium and the ability of its outer membrane proteins to adhere to the epithelial cells of the gastric mucosa.

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Pharmacodynamics

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

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

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Pharmacokinetics

After oral administration, Clarithromycin is rapidly absorbed from the gastrointestinal tract and enters the systemic circulation; the highest concentration of the drug in plasma is observed on average 2.5 hours after administration. Bioavailability is about 50%.

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

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

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Dosing and administration

According to the first Helicobacter pylori eradication regimen, 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 recommended to take Omeprazole (a proton pump inhibitor) - 2-4 capsules (0.02 g) twice a day. The course of treatment usually lasts 10 days.

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

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Use antibiotics for gastritis during pregnancy

Clarithromycin has a category C effect on the fetus (according to the FDA), its use is prohibited in the first three months of pregnancy, including for the treatment of gastritis.

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

Contraindications

Contraindications for Clarithromycin include:

• children under 12 years of age (for tablets);
• severe liver and/or kidney failure;
• history of prolongation of the QT interval or ventricular cardiac arrhythmia;
• hypoglycemia.

According to the instructions, Amoxicillin is contraindicated for use in the following cases:

• 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 to treat children under 10 years of age.

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Side effects antibiotics for gastritis

Clarithromycin may cause the following side effects: nausea, vomiting, taste changes and diarrhea; headache and abdominal pain; increased blood glucose levels; mycosis of the oral mucosa; urticaria; dizziness, sleep disturbances, tachycardia; the possibility of developing anaphylactic shock cannot be ruled out.

Side effects of Amoxicillin include allergic reactions and, if immunity is reduced, the development of superinfections.

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Overdose

In cases of overdose of the indicated antibacterial drugs, an increase in side effects is observed; it is recommended to perform a regular gastric lavage.

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Interactions with other drugs

Concomitant use of Clarithromycin with anticonvulsants, bronchodilators, H1-histamine receptor blockers, benzodiazepine tranquilizers, and ergot-based agents enhances their effects.

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

The combined use of Amoxicillin with aminoglycoside antibiotics and laxatives reduces its absorption in the gastrointestinal tract, while ascorbic acid increases it.

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Storage conditions

Antibiotics for gastritis - Clarithromycin and Amoxicillin should be stored in a dark place at a temperature not exceeding +25°C.

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Shelf life

The shelf life of both drugs is 24 months.

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