Effective and safe pharmacotherapy in the treatment of HP-associated diseases of the stomach and duodenum
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Department of Digestive Organ Pathology, Republican Specialized Scientific-Practical Center of Therapy and Medical Rehabilitation, Ministry of Health of the Republic of Uzbekistan, Tashkent
According to the final document of the Maastricht-2 Consensus, peptic ulcer disease (PUD) is the main indication for H. pylori eradication therapy, regardless of the disease phase. The listed indications contradict the principles of rational antibiotic therapy. The simultaneous use of two or more antibacterial drugs inevitably affects the intestinal microbiocenosis, especially if it was initially impaired, which is the case for the vast majority of gastroenterological patients [5].
Research Objectives
The required efficacy criterion for the used eradication therapy (ET) regimens, according to the Maastricht Consensuses, is an eradication rate of at least 80.0%. While at the beginning of using the standard "triple" ET with double-dose proton pump inhibitors (PPIs), amoxicillin, and clarithromycin for 7 days this met the requirements, over time (less than 5 years) the effectiveness of this treatment regimen universally decreased to 65–75% [4, 6, 7]. The reasons considered include H. pylori resistance to antibacterial drugs, patients' non-adherence to treatment recommendations, and the development of side effects associated with antibiotic intake, manifested as gastrointestinal dysfunction, which worsens patients' adherence to treatment recommendations. This, in turn, necessitated the development of treatment regimens with extended ET durations of 10–14 days, as well as second-line and rescue therapies [8]. The objectives of ET are not only to reduce clinical manifestations and prevent disease recurrence but also to avoid gastrointestinal complications.
Research Objectives
Comparative evaluation of the eradication efficacy of a representative macrolide – Ekozitrin® (ABBA RUS) (clarithromycin + lactulose) in the complex anti-Helicobacter therapy of patients with H. pylori-associated gastric diseases (CG and DU).
Ekozitrin® belongs to the new modern group of drugs – eco-antibiotics – and represents an innovative pharmaceutical composition consisting of a traditional antibiotic in a standard dosage and an effective prebiotic – anhydrous lactulose. For the production of eco-antibiotics, not ordinary lactulose is used, but lactulose in an improved, high-tech form – anhydrous. Anhydrous lactulose fundamentally differs from ordinary lactulose, which is part of other drugs, by its highest degree of purification. Ordinary lactulose is used in pharmaceuticals as a 65% syrup and contains a significant amount (about 35%) of impurities. In contrast, anhydrous lactulose contains 97–99% pure lactulose, and the total amount of impurities does not exceed 3%. The ratio of components in the eco-antibiotic ensures the delivery of prebiotic doses of anhydrous lactulose to the intestine, stimulating the growth and reproduction of the main components of the normal microflora – bifidobacteria and lactobacilli.
Thus, this disaccharide normalizes the balance and restores the functions of the normal microflora, being a bifidogenic and lactogenic prebiotic, for which lactulose serves as a nutrient substrate, leading to an increase in their biomass. Trials on healthy volunteers have shown that against the background of taking prebiotic doses of lactulose, the population density of bifidobacteria increases by 1.5 times compared to the initial level.
Detailed Description
The full text of the article is available in the file ""Effective and Safe Pharmacotherapy for the Treatment of H. pylori-Associated Gastric and Duodenal Diseases".
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