Chronic NSAID users have a 2-4% risk of developing a symptomatic ulcer, GI bleeding, or perforation. Ideally, NSAIDs should be discontinued in patients with an ulcer if at all possible. Healing of ulcers despite continued NSAID use is possible with the use of acid-suppressant agents, usually at higher doses and for a considerably longer duration than standard regimens
Triple therapy X 14 days: [Proton pump inhibitor + clarithromycin 500 mg + (metronidazole 500 mg or amoxicillin 1 g)] twice a day. (Tetracycline 500 mg can be substituted for amoxicillin or metronidazole.)
Quadruple therapy X 14 days: Proton pump inhibitor twice a day + metronidazole 500 mg three times daily + (bismuth subsalicylate 525 mg + tetracycline 500 mg four times daily)
H2 receptor antagonist twice a day + (bismuth subsalicylate 525 mg + metronidazole 250 mg + tetracycline 500 mg) four times daily
Proton pump inhibitors: H2 receptor antagonists:
Omeprazole: 20 mg Cimetidine: 400 mg
Lansoprazole: 30 mg Famotidine: 20 mg
Rabeprazole: 20 mg Nizatidine: 150 mg
Pantoprazole: 40 mg Ranitidine: 150 mg Esomeprazole: 40 mg
(e.g., 8 weeks or longer). Again, proton pump inhibitors are superior to H2 receptor antagonists and misoprostol in promoting the healing of active ulcers (healing rates of 80—90% for proton pump inhibitors versus 60—75% for the H2 receptor antagonists) and in preventing recurrence of gastric and duodenal ulcers in the setting of continued NSAID administration.
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