Omeprazole Amoxicillin

Amoxicillin 1 g three times a day + omeprazole 20 mg twice a day Clarithromycin 500 mg three times a day + omeprazole 40 mg every day... 

The therapy prescribed is a 1-week triple therapy regimen consisting of amoxicillin, clarithromycin and omeprazole against Helicobacter pylori infection. 

III. Eradication of Helicobacter pylori C. This microorganism plays an important role in the pathogenesis of chronic gastritis and peptic ulcer disease. The combination of antibacterial drugs and omeprazole has proven effective. In case of intolerance to amoxicillin (p. 270) or clarithromycin (p. 276), metronidazole (p. 274) can be used as a substitute. Colloidal bismuth compounds are also effective however, the problem of heavy-metal exposure compromises their long-term use. 

Dual therapy - In combination with clarithromycin (omeprazole) or amoxicillin (lansoprazole). 

Triple therapy (omeprazole/clarithromycin/amoxiclllin)- Omeprazole 20 mg plus clarithromycin 500 mg plus amoxicillin 1000 mg each given twice/day for 10 days. If an ulcer is present at the initiation of therapy, continue omeprazole 20 mg for an additional 18 days. 

Clarithromycin/Omeprazole/Amoxicillin- 500 mg clarithromycin, 20 mg omeprazole, and 1 g amoxicillin every 12 hours for 10 days. In patients with an ulcer present at the time of initiation of therapy, an additional 18 days of omeprazole 20 mg once daily is recommended for ulcer healing and symptom relief. 

The study population consisted of CYP2C19-genotyped patients infected with H. pylori who had completed initial treatment with omeprazole 20 mg or lansoprazole 30 mg twice daily, and clarithromycin 200 mg and amoxicillin 500 mg three times a day for 1 week. Patients in whom the infection was not eradicated after initial treatment were retreated with lansoprazole 30 mg and amoxicillin 500 mg four times a day for 2 weeks. 

J. Labenz, et al., Omeprazole plus amoxicillin Efficacy of variants treatment regimes to eradicate Helicobacter pylori. Am. J. Gastroenterol. 88 491-495, 1993. 

H. pylori infections are normally treated by a triple therapy course over a week, namely two antibiotics plus an acid inhibitor, for example amoxicillin, clarithromycin and a PPI such as omeprazole. 

The MACH-2 study has assessed the role of omeprazole in triple therapy in 539 patients with duodenal ulcers associated with H. pylori (3). The addition of omeprazole resulted in significantly higher eradication rates (over 90%) than antibiotics alone (amoxicillin plus clarithromycin about 25% clarithromycin plus metronidazole 70%), and reduced the impact of primary resistance to metronidazole. About one-third of the patients who took amoxicillin reported diarrhea/loose stools. The frequency of taste disturbance was dose-dependent with clarithromycin. Increased liver enzymes were more commonly reported in those taking metronidazole. The addition of omeprazole did not increase the frequency of reported adverse effects. 

The DU-MACH study assessed the efficacy of two omeprazole-based triple therapies (omeprazole, amoxicillin, clarithromycin versus omeprazole, metronidazole, clarithromycin) given for 1 week to 149 patients for eradicating H. pylori, healing duodenal ulcers, and preventing ulcer relapse over 6 months after treatment (4). Both regimens achieved high eradication rates (about 90%) and were well tolerated. Adverse effects were similar in the two groups, and included diarrhea, taste disturbance, headache, nausea, and dyspepsia. 

Ranitidine 300 mg bd and omeprazole 20 mg bd have been compared as components of triple therapies (combining them with either amoxicillin plus clarithromycin or amoxicillin plus metronidazole) in 320 patients with H. pylori (5). Omeprazole and ranitidine combined with two antibiotics for 1 week were equally effective in eradicating H. pylori. This result questions the role of profound acid suppression in eradication. There was no difference in the reported adverse effects, which included nausea, vomiting, diarrhea, metallic taste, skin rashes, and headache. 

In a similar study in 221 patients with peptic ulcer disease associated with H. pylori, rabeprazole has been compared with omeprazole and lansoprazole (combining them with amoxicillin plus clarithromycin for 1 week) (6). Rabeprazole was as effective as omeprazole and lansoprazole in eradicating H. pylori (84-88% each). There were no differences in reported adverse events. Common adverse effects were soft stools, glossitis, taste disturbances, and skin rashes. 

Dual therapy (omeprazole plus clarithromycin) for 2 weeks has been compared with triple therapy (omeprazole plus amoxicillin and clarithromycin) for 1 week in the eradication of H. pylori in 145 patients with duodenal nlcers (7). Triple therapy was significantly more effective in eradicating H. pylori (71 versus 48%). There were no significant differences in comphance or adverse effects. The most freqnent adverse effects were metallic taste and nansea in the dnal-therapy gronp and metalhc taste, mild abdominal pain, and diarrhea in the triple-therapy group. 

Quadruple therapy (omeprazole, amoxicUhn, roxithromycin, and metronidazole for 1 week) has been studied in an open trial in 169 patients with H. pylori (8). This regimen achieved an eradication rate of 92%. It was also beneficial in patients infected with pretreatment resistant strains to the antibiotics, in which cases the eradication rates achieved (over 90%) were similar to eradication rates in patients infected with sensitive strains. Compliance was good and there was only one serious adverse effect, anaphylaxis, probably due to amoxicillin. Frequent adverse effects were abdominal distension (10%), glossitis (9%), and diarrhea (8%). 

In an open trial, 7-day triple therapy with omeprazole 30 mg bd, amoxicillin 500 mg tds, and clarithromycin 400 mg bd was safe and effective in eradicating H. pylori in 12 of 13 patients undergoing hemodialysis (10). There were adverse effects in two patients (compared with three of 27 patients not undergoing hemodialysis) and treatment had to be discontinued in one, owing to severe nausea and vomiting. 

Triple therapy with bismuth plus amoxicillin and metronidazole for 2 weeks has been compared with dual therapy with omeprazole plus amoxicillin for 2 weeks in 126 patients over the age of 60 years, who were H. pylori positive and had functional dyspepsia (16). Eradication rates were similar in the two groups 2 months after the end of therapy (66% with triple therapy and 64% with dual therapy), and there was a significant reduction in dyspeptic symptoms in patients... 

The effect of adding adherence-enhancing measures to triple therapy with omeprazole plus amoxicillin and metronidazole for 10 days has been studied in 119 Australian patients with H. pylori infection (17). The adherence-enhancing measures were ... 

Laine L, Suchower L, Frantz J, Connors A, NeU G. Twice-daily, 10-day triple therapy with omeprazole, amoxicillin, and clarithromycin for Helicobacter pylori eradication in duodenal ulcer disease results of three multicenter, double-blind, United States trials. Am J Gastroenterol 1998 93(11) 2106-12. 

In the eradication of Helicobacter pylori, metronidazole plus bismuth is effective, but causes more adverse effects than omeprazole plus amoxicillin plus either clarithromycin or metronidazole. 

Wolf R+, Dermatol Online J 9(3), 2 (with amoxicillin and omeprazole)... 

Clinically important, potentially hazardous interactions with acitretin, aldesleukin, aminoglycosides, amiodarone, amoxicillin, ampicillin, aspirin, bacampicillin, bismuth, carbenicillin, chloroquine, cisplatin, cloxacillin, co-trimoxazole, dapsone, demeclocycline, dexamethasone, diclofenac, dicloxacillin, etodolac, etoricoxib, etretinate, fenoprofen, flurbiprofen, folic acid antagonists, haloperidol, hydrocortisone, ibuprofen, indomethacin, influenza vaccines, ketoprofen, ketorolac, lithium, magnesium trisalicylate, meclofenamate, mefenamic acid, methicillin, mezlocillin, minocycline, nabumetone, nafcillin, naproxen, NSAIDs, omeprazole, oxacillin, oxaprozin, oxytetracycline, paromomycin, penicillin G, penicillin V, penicillins, phenylbutazone, piperacillin, piroxicam, polypeptide antibiotics, prednisolone, prednisone, probenecid, procarbazine, rofecoxib, salicylates, salsalate, sapropterin, sulfadiazine, sulfamethoxazole, sulfapyridine, sulfasalazine, sulfisoxazole, sulindac, tazobactum, tenoxicam, tetracycline, ticarcillin, tolmetin, trimethoprim, vaccines... 

Regarding proton pump inhibitors, the effect of CYP2C19 PM status is not limited to pharmacokinetic alterations. The difference in the pharmacokinetics has been shown to influence the outcome of H. Pylori eradication therapy. Furuta et al. showed that in patients with confirmed H. Pylori infection treated with omeprazole or lansoprazole plus clarithromycin and amoxicillin, CYP2C19 PMs had an eradication rate of 97.8% compared with a rate of 72.7% (P < 0.001) for CYP2C19 EMs (51). 

The presence of a defective CYP2C19 allele has been associated with improved Helicobacter pylori cure rates after dual (omeprazole and amoxicillin) or triple therapy (omeprazole, amoxicillin, and clarithromycin) with omeprazole, as weU as with lansoprazole. This difference likely reflects the higher achievable intragastric pH in the PM group. The cure rate achieved with dual therapy was 100% in PMs compared with 60% and 29% in heterozygous and homozygous EMs, respectively. In two studies, EMs had H. pylori... 

Proton pump inhibitor-based three-drug regimens Omeprazole 20 mg twice daily Clarithromycin 500 mg twice or lansoprazole 30 mg twice daily daily or pantoprazole 40 mg twice daily or esomeprazole 40 mg daily or rabeprazole 20 mg daily Bismuth-based four-drug regimens Amoxicillin 1 g twice daily or metronidazole 500 mg twice daily ... 

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