Experience in using various regimens for eradication of Helicobacter pylori infection in patients who had COVID-19 and received antibacterial therapy

Abstract Objective. Study of the effect of rebamipide on the effectiveness of eradication therapy (ET) of Helicobacter pylori (Hp) infection in patients who had COVID-19 and received antibacterial therapy (ABT). Materials and methods. The study involved 144 patients with Hp-associated pathology (dyspepsia, chronic gastritis, erosive and ulcerative lesions of the gastroduodenal mucosa) aged 18 to 70 years: 57 men (39.59 %), 87 women (60.41 %). Four groups of patients were identified. Group 1 included 75 people who received non-macrolide-containing antibiotics for the treatment of COVID-19 infection. ET of Hp infection included rabeprazole (Rab) 20 mg, amoxicillin (Am) 1000 mg, clarithromycin (Cl) 500 mg, bismuth tripotassium dicitrate (BTD) 240 mg 2 times a day for 14 days. Group 2 – 25 patients received antibiotics for the treatment of COVID-19 infection that did not contain macrolides. The treatment regimen for Hp infection included Rab 20 mg, Am 1000 mg, Cl 500 mg, VTD 240 mg 2 times a day with the addition of rebamipide (Reb) 100 mg 3 times a day for 14 days. After 14 days of ET, Reb intake at 100 mg 3 times a day was extended for another 14 days. Group 3 – 27 patients received antibiotics for the treatment of COVID-19 infection that contained macrolides (azithromycin). The treatment regimen for Hp infection included Rab 20 mg, Am 1000 mg, Cl 500 mg, VTD 240 mg 2 times a day with the addition of Reb 100 mg 3 times a day for 14 days. After 14 days of ET, Reb 100 mg 3 times a day was extended for another 14 days. Group 4 – 17 people, received ABT for the treatment of COVID-19 infection, containing macrolides (azithromycin). They underwent quadruple therapy for Hp infection for 14 days according to the scheme: Rab 20 mg 2 times a day, tetracycline 500 mg 4 times a day, metronidazole 500 mg 3 times a day and VTD 240 mg 2 times a day. The effectiveness of ET was assessed 4 or more weeks after the discontinuation of antibiotics, VTD and Reb using qualitative rapid determination of Hp antigens in feces by immunochromatography with monoclonal antibodies (reagent kit "Express test" H. pylori Ag", Russia). Results. In the first group of 75 patients, Hp eradication was 90.6 % (68 patients). The inclusion of Reb in the ET regimen for Hp infection in 25 patients of the second group increased the effectiveness of treatment compared to the first group from 90.6 % to 96.0 % (OR = 2.471). In 27 patients of the third group, the inclusion of Reb in the ET regimen increased the effectiveness compared to the first group from 90.6 % to 92.5 % (OR = 1.677). In 17 patients of the fourth group who had COVID-19 and received macrolides, "classical" quadruple therapy for 14 days was effective in 88.2 %, not satisfying the accepted criteria for effectiveness – more than 90 %. Conclusions. Our results show that the inclusion of rebamipide in order to increase the effectiveness of eradication therapy for Hp infection is advisable in patients who have had COVID-19 and received antibacterial therapy, including macrolides.