Effective treatment with 4-drug regimen

Dan Tri e-newspaper reported on the article “Gastric ulcers caused by drug-resistant HP: Effective treatment with 4-drug regimen” on May 9, 2025. To update information to customers, we will quote content from Dan Tri Newspaper to provide to readers.

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One of the reasons why stomach diseases are not cured is due to the antibiotic resistance of HP bacteria. Therefore, updating treatment regimen is important in treating this disease.

Helicobacter pylori (HP) bacteria is one of the leading causes of peptic ulcers, and is also a factor leading to the risk of gastrointestinal bleeding, even stomach cancer. In Vietnam, the rate of HP infection is about 70-80% depending on each study and not all cases of HP infection need treatment. Cases that need treatment are cases of HP infection accompanied by symptoms of stomach diseases and stomach damage such as inflammation, ulcers, or have risk factors that increase the possibility of stomach cancer.

However, the treatment of HP bacteria today is not a simple story. HP bacteria in the past from the year 2000 were very sensitive to antibiotics so they were easy to destroy. Nowadays, the situation of antibiotic resistance in Vietnam is very high so the treatment to destroy HP is becoming more and more difficult.

The case of patient Nguyen Thi V. (54 years old, Hanoi ) is a clear demonstration of the drug resistance of HP bacteria. On July 16, 2024, Ms. V. came to the Department of Gastroenterology - Thu Cuc International General Hospital with dull pain in the epigastric region, abdominal distension, no fever, no vomiting.

Through examination, the doctor noted an ulcer at the angle of the lesser curvature of the stomach measuring 1.5 cm, with a blood clot and bleeding, and a positive test for HP bacteria. Ms. V's case is a case of HP infection accompanied by a severe ulcer, so it is necessary to treat the ulcer along with HP eradication. At Thu Cuc International General Hospital, the doctors treated the ulcer to stop bleeding, however, Ms. V wished to transfer to another hospital for continued treatment.

Mrs. V's endoscopy results in July 2024 - Small curvature ulcer with gastrointestinal bleeding

A representative of Thu Cuc International General Hospital said that at another hospital where Ms. V was transferred, Ms. V. was given a 3-drug regimen including PPI, Klacid and Amoxicillin for 14 days, but her symptoms did not improve significantly. In October 2024, Ms. V returned to Thu Cuc International General Hospital for a re-examination. After examination, the doctors found that the old ulcer had not healed, was still edematous and had many pseudomembranes, and the HP test result was still positive. This is a typical case showing the failure of the treatment regimen due to drug-resistant HP bacteria.

Mrs. V's endoscopy results in October 2024: The ulcer is still there.

Using 4-drug regimen in the treatment of drug-resistant HP bacteria

After assessing Mrs. V's condition, Thu Cuc International General Hospital prescribed a new treatment regimen for Mrs. V, including 4 drugs: PPI + Bismuth + Tetracycline + Metronidazole for 14 consecutive days. Mrs. V. followed the treatment as directed. After completing the treatment, the unpleasant symptoms such as abdominal pain, bloating, nausea disappeared, her appetite improved, and her sleep also improved significantly. On March 20, when re-examined with an endoscopy, the stomach ulcer had healed, there was no more edema or pseudomembrane. At the same time, the HP test was negative.

Doctor examines and consults patient

General Secretary of the Vietnam Gastroenterology Association, Associate Professor, Dr. Vu Van Khien, who is also Deputy Director in charge of gastrointestinal endoscopy at Thu Cuc International General Hospital and Vice President of the Vietnam Gastroenterology Association, said that in 2022, the Vietnam Gastroenterology Association reached a consensus on diagnosis and treatment of HP eradication, with a recommendation to use a 4-drug regimen containing Bismuth. “Specifically applied to this patient, we used a 4-drug regimen containing Bismuth for 14 days and the results were excellent. The ulcer healed and the HP bacteria were eradicated,” he said.

Mrs. V's endoscopy results in March 2025: The ulcer has healed.

Associate Professor, Dr. Vu Van Khien added that according to the recommendations of the Vietnam Gastroenterology Association as well as the world , when the rate of clarithromycin antibiotic resistance in residential areas is over 20%, it is necessary to consider when using the treatment regimen. Currently, the drug resistance of HP in Vietnam is increasing (Clarithromycin resistance: 34%, Metronidazole resistance: 70%), so the 3-drug regimen (PPI + Amoxicillin and Klacid) has reduced the effectiveness of HP eradication and caused ulcers to not heal. The Vietnam Gastroenterology Association recommends using the 4-drug regimen containing Bismuth as a priority option in cases of treatment failure.

Modern colonoscopy technology at Thu Cuc TCI

Thu Cuc International General Hospital is one of the pioneering hospitals in updating the latest domestic and foreign treatment regimens in the treatment of HP in particular and digestive diseases in general to ensure optimal treatment effectiveness and minimize drug resistance. Associate Professor Khien said that most of the patients treated here are effective after a period of active treatment with international standard regimens. However, there are some patients who do not respond to the classic treatment regimen due to strong drug resistance and will be prescribed by doctors to continue with new specific regimens.

Thu Cuc TCI Healthcare System is a trusted address for examination and treatment of digestive diseases, gathering a team of highly specialized doctors and modern endoscopic technology. For more information, readers can see more at:

Website: https://benhvienthucuc.vn/noi-soi-tieu-hoa-ung-dung-cong-nghe-dot-pha/

Consulting hotline: 1900 55 88 92

Source: https://benhvienthucuc.vn/718492-2/