The health care provider is treating a patient with complaints of severe abdominal pain and confirmed infection with H. pylori. Which of the following medication combinations would the nurse expect the health care provider to order?
a. cimetidine (Tagamet) and metronidazole (Flagyl)
b. cimetidine (Tagamet), tetracycline, and cefuroxime (Ceftin)
c. clarithromycin (Biaxin), amoxicillin (Amoxil), and esomeprazole (Nexium)
d. amphotericin B, cimetidine (Tagamet), and bismuth (Pepto-Bismol)
The antibiotics administered most often are amoxicillin, clarithromycin, bismuth, metronidazole, and tetracycline. None is effective alone, hence the combination of clarithromycin and amoxicillin. The antibacterial activity of amoxicillin is highest at a neutral pH and can be enhanced by reducing gastric acidity with an antisecretory agent, such as esomeprazole. This combination is an appropriate treatment plan.
Metronidazole is very effective against sensitive strains; however, more than 40% of strains are now resistant. One antibiotic alone is not effective in treating H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.
Although two antibiotics are included, only tetracycline is effective against H. pylori. Cimetidine promotes healing of ulcers, therefore it would be an important drug to include in the treatment plan.
Although cimetidine and bismuth are appropriate in the treatment plan, amphotericin B is an antifungal agent and would have no effect on H. pylori.