17 Aug Week 6 Drug table
Since the patient has lost 6lbs and has a positive H-pylori test I would start medication therapy. Latest studies have shown that triple therapy with a PPI, Clarithromycin and Amoxicillin has the best results in eradication. Antibiotics will be needed to cure the H-pylori bacteria. Since the medications to cure H-pylori cause gastric upset, omeprazole will also be needed. Antibiotic resistance phenomena are now observed with a certain frequency in H pylori infections; occasionally, even after the use of different eradicating protocols, H pylori is not eradicated. In such cases treatment with rifabutin may be indicated (Center for Disease Control, 2018).
How long would you prescribe these medications?
The medications would be prescribed for 14 days with the omeprazole being given for an extra 14 days. Also, dietary changes, and cessation of smoking which are central to the management of both H-pylori and GERD should be initiated. Anti-reflux maneuvers reduce back pressure on the LES from intra-abdominal contents. Dietary changes reduce the total volume and acid content of the stomach. Smoking reduces LES tone and increases gastric acid secretion Woo & Robinson, 2016).
What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
Maintenance therapy with an antisecretory agent is not generally required after eradication of H. pylori. However, it is prudent to prescribe maintenance therapy for certain high-risk groups: smokers; patients older than 60 years; patients with chronic obstructive pulmonary disease, coronary artery disease, or renal failure; patients with a history of bleeding or perforated ulcer; patients with persistent symptoms; and those who must take NSAIDs or other ulcerogenic drugs (Woo & Robinson, 2016). Antidiarrheals may also be needed.
How would the treatment vary if the patient has GERD instead?
If the patient had GERD instead antibiotic therapy would not be needed, however the first steps of treatment would be the same. The patient would still start with over the counter antacids and diet changes. However, for most patients, GERD is treated with PPI therapy. Maintenance PPI therapy should be prescribed for patients who have symptoms that recur after PPI therapy is discontinued or patients with complications such as erosive esophagitis or Barrett’s esophagitis (Katz, et al). The patient should be reassessed in 6 to 12 months to determine if he or she can be weaned off therapy. Patients who do not respond to PPIs need to be referred to a gastroenterology specialist (Woo & Robison, 2016).
References
Center for Disease Control. (2018). Infectious diseases related to travel. Retrieved from https://wwwnc.cdc.gov/travel/yellowbook/2018/infectious-diseases-related-to-travel/helicobacter-pylori
Moser-Woo, T., Robinson, M. (2016). Pharmacotherapeutics for Advanced Practice Nurse Prescribers. 4th ed. Philadelphia, PA: F. A. Davis Company
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