What would you prescribe initially?
Based on the examination and assessment, the patient under consideration suffers from peptic ulcer disease (PUD). The initial prescription for his case would be over-the-counter antacids and histamine 2 blockers, as well as lifestyle modifications (Woo, 2016). However, in case with PUD, many patients try some interventions prior to seeking health care. Mike has already resorted to famotidine and ranitidine, so it is necessary to move to the second step of the initial treatment. Such a decision is relevant to the patient’s case since it is particularly recommended for individuals with a positive H. pylori test (Woo, 2016).
Therefore, the initial prescription would include maintenance therapy with an antisecretory agent. Particularly, I would prescribe proton pump inhibitors (PPI), amoxicillin, and clarithromycin for this patient as the most common recommendation. An alternative triple-drug regimen would be metronidazole instead of amoxicillin (Fashner & Gitu, 2015). I would try this regimen in case Mike proved to be amoxicillin-resistant.
What concerns the major lifestyle modifications, they should include smoking cessation (in case Mike smokes), dietary changes, and stress management. Smoking is known not only to raise the risk for duodenal and gastric ulcers but also to slow down their healing (Woo, 2016). Therefore, if the patient smokes, this habit should be eradicated in order to promote the treatment process. Dietary adjustments are crucial for all patients with diseases of the gastrointestinal system. The major change concerns the amount of food and the frequency of intake.
Thus, I would recommend Mike to eat small portions of food several times a day rather than eat much only two or three times per day. Another dietary change would be the minimized consumption of alcohol, fruit juices, spices, and caffeine (Woo, 2016). The selection of dietary modification should depend on individual characteristics of the patient and upon the detailed analyses and tests that could indicate the most problem-causing types of food. Finally, controlling stress would be recommended to Mike since stressful situations are also known to deteriorate PUD.
How long would you prescribe these medications?
The most common duration of the first-line therapy aimed at the eradication of H. pylori is seven-ten days. The triple-drug regimen includes PPI, amoxicillin 1g, and clarithromycin 500mg twice a day (Fashner & Gitu, 2015). The latest research results indicate that there is a growing tendency of patients’ resistance to clarithromycin, which sometimes reaches up to 80% (Fashner & Gitu, 2015). Thus, such a regimen would not be advised in case Mike’s resistance to clarithromycin exceeded 15-20%. The alternative treatment with metronidazole instead of amoxicillin is also recommended for seven to ten days to assess the effects on the patient.
What other possible meds could you prescribe to assist with the side effects from the medications prescribed?
Although adverse effects of PUD treatment are not common, some still may occur in rare cases. The most typical side effects include diarrhea, constipation, nausea, and headache. To eliminate the development of adverse outcomes of treatment, adding probiotics to the triple therapy is recommended. In particular, Lactobacillus and Saccharomyces boulardii are reported to decrease the side effects in general by 14% and diarrhea in particular by 7% (Fashner & Gitu, 2015).
How would the treatment vary if the patient has GERD instead?
If the patient had gastroesophageal reflux (GERD), there would be some different approaches to treatment. First of all, lifestyle changes would play a much more crucial role in that case than in PUD (Woo, 2016). Apart from smoking cessation and dietary changes, such a lifestyle modification as antireflux maneuvers would be recommended to decrease back pressure on the lower esophageal sphincter from intra-abdominal contents (Woo, 2016). Another difference would be the duration of PPI therapy, which, in this case, would reach eight weeks.
References
Fashner, J., & Gitu, A. C. (2015). Diagnosis and treatment of peptic ulcer disease and H. pylori infection. American Family Physician, 91(4), 236-242.
Woo, T. M. (2016). Gastroesophageal reflux and peptic ulcer disease. In T. M. Woo & M. V. Robinson (Eds.), Pharmacotherapeutics for advanced practice nurse prescribers (4th ed.) (pp. 1021-1034). Philadelphia, PA: F. A. Davis Company.