Modern opportunities to improve the effectiveness of eradication therapy on a clinical case

Abstract

Today, one of the significant and urgent problems of gastroenterology is Helicobacter pylori infection, which is one of the most common causative agents of chronic infections in humans. The problems of its diagnosis, and to a greater extent therapy, continue to be the subject of numerous consensuses and recommendations. The effectiveness of Helicobacter pylori eradication therapy is quite acute, taking into account both the characteristics of the microorganism itself, the growing antibiotic resistance and the decrease in patients’ adherence to therapy. The choice of treatment regimen is determined by a number of regional characteristics, including indicators of H. pylori resistance to clarithromycin and nitroimidazole, as a result of which regional recommendations are being developed in a number of countries. At the same time, the summary data on the resistance of H. pylori to clarithromycin in Russia do not allow us to speak about high rates of this problem. Therefore, clarithromycin can be used in first-line therapy as an effective component of eradication therapy. At the same time, an important measure to improve the effectiveness of H. pylori eradication is to increase the adherence of patients to therapy, which consists in talking with the patient, providing complete information about the disease, its complications, the need to follow all recommendations and taking prescribed drugs, keeping a patient diary, and, if necessary, telephone contact with the patient. In addition, it is possible to influence compliance by increasing it by prescribing a fixed combination of drugs in one package. An example of this approach is the drug combination of omeprazole, clarithromycin and amoxicillin. This article presents a small review of the literature on the reasons for unsuccessful H. pylori eradication, considers possible ways to improve it, and analyzes a clinical case with a discussion of rational pharmacocorrection.