Dlaczego nie należy przerywać terapii inhibitorami pompy protonowej i antybiotykami stosowanymi w eradykacji Helicobacter pylori w czasie pandemii COVID-19?

Abstract

Helicobacter pylori infection is one of the most widespread infectious diseases in the world, but its prevalence varies depending on geographical region and economic and social condition. The percent of infected adult persons in Poland is 67, among younger population under 18 years being as high as about 32%. This infection in some number of the concerned persons can be associated with chronic gastritis, peptic gastric and duodenal ulcers, gastric mucosa-associated lymphoid tissue lymphoma (MALT) and gastric cancer. Extra-gastric manifestation of H. pylori infection are iron deficiency anemia, idiopathic thrombocytopenic purpura and significant B12 deficiency. According to the Maastricht V/Florence Consensus Report considering H. pylori infection a contagious disease that requires treatment in each case, indications for diagnostic evaluation to detect its presence are established, and then to its eradication. The treatment of H. pylori infection is complex and based on the combination of the following groups of medicines: proton pump inhibitors (PPI), antibiotics and anti-microbial nitroimidazoles and bismuth salts and probiotics. Currently, the main challenge in the field of H. pylori infection is antibiotic resistance, which influences the efficacy of eradication regiments. According to Maastricht V/Florence Consensus, in Poland where H. pylori resistance to clarithromycin is more than 15%, quadruple therapy with bismuth, PPI, tetracycline and metronidazole/tinidazole for 10–14 days should be used as first-line treatment. Triple therapy with fluoroquinolone is recommended as second-line treatment. After two unsuccessful attempts to eradicate, bacterial cultures should be should be performed to asses antibiotic sensitivity of the H. pylori strain. There are no reasons in front of pandaemia of COVID-19 to delay eradication of H. pylori infection, when the urgent indications: peptic ulcer complicated with haemorrhage, MALT lymphoma or early gastric cancer exists.