A third option (if atrophy of the gastric mucosa with achlorhydria, confirmed by pH-meter). Amoxicillin (500 mg four times a day or 1000 mg two times a day) combined with combined with clarithromycin (500 mg, 2 times daily) and bismuth tripotassium dicitratobismuthate (120 mg four times a day or 240 mg 2 times daily) duration of 10-14 days.
Said standard does not recommend the use of clarithromycin during the second-line therapy of H. pylori (ie in the absence of the success of the therapy on the first line).
The problem anitibiotkorezistentnosti Helicobacter pylori to clarithromycin
Treatment with clarithromycin, like other antibacterial agents, is not always successful because of the emergence and spread of strains of microorganisms resistant clarithromycin. Since 1996, the Russian Gastroenterological Association held the dynamic observation of the levels of Helicobacter pylori antibiotic resistance to various antibiotics, including clarithromycin. So, for the period from 1996 to 2001. number of strains resistant to clarithromycin from 0 to 13.8% increase in Russian, but then there has been a downward trend in the level of resistance to this antimicrobial drug (Maiev IV, Vyuchnova ES, Shchyokino MI). Recently Helicobacter pylori resistance in Russia (Hp) to clarithromycin reached 28-29%.
Therefore, antibiotics began to appear, replacing clarithromycin in triple eradication therapy: from macrolides - josamycin, in pediatrics - Enterofuril group of nitrofurans (Minushkin ON et al.).