Esomeprazole + Amoxicillin + Clarithromycin

Esomeprazole + Amoxicillin + Clarithromycin belongs to the anti-H. pylori drugs group. Doctors prescribe it mainly for the eradication of H. pylori in active chronic gastric, duodenal and gastric ulcers.

Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production. Amoxicillin is similar to penicillin in its bactericidal action against susceptible bacteria during the stage of active multiplication. Clarithromycin acts by inhibiting microsomal protein synthesis in susceptible organisms.

• H. pylori Eradication: Indicated for the eradication of H. pylori in active chronic gastric, duodenal and gastric ulcers.

Anti H. pylori drugs

Proton Pump Inhibitor + Penicillin Antibiotic + Macrolide Antibiotic

Esomeprazole exerts its stomach acid-suppressing effects by preventing the final step in gastric acid production by covalently binding to sulfhydryl groups of cysteines found on the (H+, K+)-ATPase enzyme at the secretory surface of gastric parietal cells. Amoxicillin is similar to penicillin in its bactericidal action against susceptible bacteria during the stage of active multiplication. Clarithromycin acts by inhibiting microsomal protein synthesis in susceptible organisms mainly by binding to the donor site on the 50S subunit of the bacterial ribosome and preventing translocation to that site.

Esomeprazole inhibits gastric acid production by blocking (H+, K+)-ATPase enzyme. Amoxicillin kills bacteria by inhibiting cell wall biosynthesis. Clarithromycin inhibits protein synthesis by binding to the 50S ribosomal subunit.

Adult Dose:

• H. pylori Eradication: Each tablet twice daily for 7-14 days or as per the physician's advice.

Take this medicine in the dose and duration as advised by your doctor. Swallow it as a whole. Do not chew, crush or break it.

If you miss a dose of this combination, take it as soon as possible. However, if it is almost time for your next dose, skip the missed dose and go back to your regular schedule. Do not double the dose.

Common Side Effects:

• Diarrhea
• Nausea

Other Side Effects:

• Abdominal pain
• Headache
• Taste alteration

Precautions:

• Serious and occasionally fatal hypersensitivity reactions have been reported in patients on Amoxicillin therapy (more likely in patients with history of penicillin hypersensitivity).
• Clarithromycin should not be used in pregnant women except in clinical circumstances where no alternative is appropriate.

Contraindications: Known hypersensitivity to any of its components.

Drug Interactions:

• Drugs metabolized by cytochrome P450 system: Esomeprazole has no clinically significant interactions (warfarin, antipyrine, indomethacin, ibuprofen, phenytoin, propranolol, prednisolone, diazepam, clarithromycin, terfenadine).
• Theophylline: Serum concentrations may increase with clarithromycin.
• Carbamazepine, Cyclosporine, Tacrolimus, Phenytoin, Disopyramide, Lovastatin, Bromocriptine, Valproate, Terfenadine, Cisapride, Pimozide, Astemizole: Interactions reported with clarithromycin.

Food Interactions: It is not known whether it is safe to consume alcohol with this combination. Consult your doctor.

Use in Pregnancy: Should only be given to pregnant women if its use is considered essential.

Use in Lactation: The safety of this combination for use during breastfeeding has not been established.

Pediatric Use: No specific dosage recommendations for children.

Geriatric Use: Although this regimen has not been specifically studied in the elderly, dosage adjustment is not needed during therapy with individual components.

Renal Impairment: No specific dosage adjustment is necessary for patients with kidney disease.

Hepatic Impairment: Use with caution in patients with liver disease.

Overdose: Limited information is available on overdose. In case of overdose, symptomatic treatment should be given and seek immediate medical attention.

Storage: Store below 30°C in a cool and dry place.

Esomeprazole + Amoxicillin + Clarithromycin