This document summarizes four drugs used in combination to treat Helicobacter pylori infection and duodenal ulcers: clarithromycin, omeprazole, amoxicillin, and bismuth subsalicylate. It provides the classification, indication, contraindications, side effects, and important nursing considerations for each drug. The drugs are commonly administered together to eradicate H. pylori bacteria and treat associated gastritis and duodenal ulcers. Nurses should monitor patients for anticipated responses and side effects and educate them about proper administration and potential symptoms like black stools.

1. X. Drug Study
Drug name Classification Indication Contraindication Side & Adverse
Effects
Nursing
considerations
Generic:
 Clarithromaycin
(Biaxin) 500 mg
tab, OD
Macrolide antibiotic
Action: Used in
combination with
anti-ulcer
medications to treat
certain types of
stomach ulcers. It
may also be used to
prevent certain
bacterial infections.
Treatment of
active duodenal
ulcer associated
with
Helicobacter
pylori in
combination
with proton
pump inhibitor
No
contraindicated
nausea
-Culture infection
before therapy.
-Do not cut or crush,
and ensure that patient
does not chew ER
tablets.
-Monitor patient for
anticipated response.
-Administer without
regard to meals;
administer with food if
GI effects occur.

2. Drug name Classification Indication Contraindication Side & Adverse
Effects
Nursing considerations
Generic:
 Omeprazole
(Losec) 20
mg, TIV
before meal
Proton pump inhibitor
Action:
Gastric acid-pump
inhibitor. Suppresses
gastric acid secretion by
specific inhibition of the
hydrogen potassium
ATPase enzymes system
at the secretory surface
of the gastric parietal
cells; block the final
stage of acid production.
Active duodenal
eradication of H.
pylori
No
contraindicated
Cough,
Nausea and
vomiting,
Dizziness.
-Assess for skin lesions;
reflexes, affect; urine
output, abdominal
exam; respiratory
auscultation.
-Caution patient to
swallow capsules
whole—not to open,
chew or crush them.

3. Drug name Classification Indication Contraindication Side & Adverse
Effects
Nursing considerations
Generic:
 Amoxicillin
(amoxil) 500
mg Tab, BID
Antibiotic
Action:
Bacteriacidal; inhibits
synthesis of cell wall of
sensitive organisms,
causing cell death..
Helicobacter
pylori infection in
combination with
other agents
No
contraindicated
No side effects
-Culture infected area
prior to treatment; re-
culture area if response is
not as expected.
-Give in oral preparations
only; amoxicillin is not
affected by food
-Continue therapy for at
least 2 days after signs of
infection have
disappeared; continuation
for 10 full days is
recommended.
-Use corticosteroids or
antihistamines for skin
reaction.
-Report any side effects
-If GI upset occurs, take
with meals

4. Drug name Classification Indication Contraindication Side & Adverse
Effects
Nursing considerations
Generic:
 Bismuth
Subsalicylate
(Bismatrol)
500 mg Tab,
BID
-antacid
-antiulcer agent
Action: Antidiarrheal—
may exert its
antidiarrheal action not
only by stimulating
absorption of fluid and
electrolytes across the
intestinal wall
(antisecretory action)
but also, when
hydrolyzed to salicylic
acid, by inhibiting
synthesis of a
prostaglandin
responsible for intestinal
inflammation and hyper
motility. Bismuth
subsalicylate and the
intestinal reaction
products, bismuth
oxychloride and bismuth
hydroxide, are believed
to have bactericidal
action.
Used, in
combination with
oral antibiotic
therapy, in the
treatment of
Helicobacter
pylori –associated
gastritis and
duodenal ulcer.
No
contraindicated
black stools,
-Counsel patient to
maintain adequate fluid
intake (2 to 3 L/day).
-Instruct patient to
notify health care
provider if diarrhea is
accompanied by high
fever or continues for
longer than 2 days or if
abdominal pain occurs.
-Advise patient not to
use medication if
concurrent viral illness
is present.
-Instruct patient to
inform health care
provider regarding
bismuth subsalicylate
administration before
any scheduled
radiologic studies or
stool examinations.
-Explain that stools
may become black or
gray and tongue may
darken.
(Reference: )