Helicobacter pylori 제균요법 : amoxicillin/clavulanic acid, 목시클 정

 

헬리코박터 파이로리 제균요법의 standard therapy에 amoxicillin을 사용한다.

 

https://gimi-drug.tistory.com/437

헬리코박터 파이로리 제균 요법, Helicobacter pylori Infection, 신부전 or 투석 환자

 

이때 beta-lactamase의 추가는 H.pylori에 더 효과적일까?

 

 

Helicobacter pylori : amoxicillin/clavulanic acid

 

1. Clavulanic acid in the scope of Helicobacter pylori treatment: a literature review and beyond

 

Background: Helicobacter pylori (H. pylori) infection is the most common cause of peptic ulcer disease and it can be associated with many complications, including malignancies. In clinical practice, some clinicians may use Clavulanic Acid (CA) in combination with amoxicillin or other beta-lactams as an addition to the standard treatment regimens. This practice may be done by habitual mistake, non-evidence based hypothetical assumptions, or by prescribing it as an alternative treatment. This review aims to expose the effect of CA against H. pylori infection and to review the possible mechanisms that may contribute to that effect.

Methods: A PubMed and Google Scholar literature search was obtained on both pre-clinical and clinical studies related to CA and H. pylori infection.

 

Results: Available clinical studies showed improvement in the eradication of H. pylori by about 10- 20% when CA was added to the treatment regimens. This effect for CA could be related to several mechanisms including inhibition of H. pylori growth by binding to Penicillin-Binding Proteins (PBPs), the transformation of H. pylori from the active filamentous form into coccoidal form, induction of the release of dopamine, modulation of immunological response towards H. pylori infection and its relationship with other microbiota. Randomized-controlled studies on patients with resistance to H. pylori are needed. Moreover, in vitro studies to evaluate the mechanisms by which CA may influence H. pylori are warranted.

 

Conclusion: The presented literature suggests potential avenues for the use of CA in the management of peptic ulcer disease and H. pylori infection.

 

reference:

Alrabadi, Nasr, et al. "Clavulanic acid in the scope of Helicobacter pylori treatment: a literature review and beyond." Current Reviews in Clinical and Experimental Pharmacology Formerly Current Clinical Pharmacology 16.2 (2021): 128-138.

 

 

2. Beta‐lactamase inhibitor enhances Helicobacter pylori eradication rate

 

Objectives. One-week triple therapy, a combination of acid suppression with two antibiotics, is the gold standard for anti-Helicobacter pylori treatment. There is increasing evidence of H. pylori resistance to classical triple therapy. Recently, it was reported that the amoxicillin–clavulanate combination had a slightly higher activity than amoxicillin alone against H. pylori, and that β-lactamase inhibitors had ‘in-vitro’ antibacterial activity against H. pylori.

 

Setting. To evaluate the efficacy of 1 week triple therapy omeprazole, clarithromycin and amoxicillin plus clavulanate compared with omeprazole, clarithromycin and amoxicillin for H. pylori eradication. The study was open randomized.

 

Subjects. Sixty dyspeptic patients (36 male, 24 female; mean age 53±9 years) with Helicobacter pylori infection never treated before, were enrolled and randomly assigned to two different 7-day triple therapies: (i) (n=30) amoxicillin 875 mg plus clavulanic acid 125 mg b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACCO); (ii) (n=30) amoxicillin 1 g b.i.d., clarithromycin 500 mg b.i.d., omeprazole 20 mg b.i.d. (ACO). Bacterial eradication was assessed by 13C-urea breath test 4–6 weeks after therapy. Information on gastrointestinal symptoms and antibiotic-related side-effects were recorded using a questionnaire.

 

Results. All patients completed the study. A significantly higher H. pylori eradication rate with ACCO compared with ACO: (26/30) 86.6 vs. (20/30) 66.6%, respectively (P<0.05) were observed. No major side-effects were reported, whilst 8% patients complained of mild side-effects; no significant differences were noted between the two groups.

 

Conclusions. Our results suggest that amoxicillin and clavulanate in combination achieve a higher H. pylori eradication rate than amoxicillin alone, without any increase in side-effects. The combination of amoxicillin and clavulanate may represent an alternative therapeutic scheme for the treatment of H. pylori infection.

 

* 한계, N수가 적음

 

 

 

아직까지 가이드라인에서 clavulanic acid에 대해서 언급X

 

 

 

하지만 국내에는 임상에 사용된 amoxicillin/clavulanic acid 용량이 없음!!

amoxicillin/clavulanic acid 1 g = amoxicillin 875 mg/clavulanic acid 125 mg

 

 

https://www.rosepharmacy.com/product/augmentin-1g-tablet/

 

 

reference:

1) Jung, Hye-Kyung, et al. "Evidence-based guidelines for the treatment of Helicobacter pylori infection in Korea 2020." Gut and liver 15.2 (2021): 168.