. A 42 yo Caucasian male who presents with 2-month history of intermittent epiga
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Question
. A 42 yo Caucasian male who presents with 2-month history of intermittent epigastric pain. The pain sometimes wakes him up at night and seems to get better after he eats a meal. He has been taking over-the-counter Zantac for 2 weeks without relief but the pain is continuing. After evaluation and physical examination at the doctor's office, the nurse calls to inform him that his urea breath test was positive and that she has phoned in a prescription for him. He is allergic to penicillin (hives). Which of the following would be the most appropriate treatment regimen?
Metronidazole + clarithromycin [Biaxin] + ranitidine [Zantac]
Metronidazole [Flagyl] + omeprazole [Prilosec] + clarithromycin [Biaxin]
Amoxicillin + tetracycline + lansoprazole [Prevacid]
Tetracycline + bismuth subsalicylate + clarithromycin [Biaxin]
Explanation / Answer
An intermittent epigastric pain specially after meals suspects stomach ulcers. A positive urea breath test confirm the Helicobacter pylori (H.pylori) in the stomach. It cause inflammations, ulcers and atrophy of the stomach. The treatment for this includes effective antibiotics such as amoxicillin, tetracyclin, metranidazole, or clarithromycin and either proton pump inhibitor or ranitidine bismuth citrate or bismutj subsalicylate. As this patient is allergic to pencillin, the suggested treatment would be- Metranidazole(Flagyl) + Omeprazole ( Prilosec) + Clarithromycin (Biaxin). Both Tetracyclin and Amoxicillin are pencillin group antibiotics.
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