Helicobacter and diarrhea after antibiotics

The May issue of The American Journal of GASTROENTEROLOGY is completely devoted to negative research results and https://pillintrip.com/de/medicine/diprospan. These are simply unreal 😱 things (for Russian science, so for sure).
And I will review several of the articles in this issue.
🔥 Everyone’s favorite topic is the development of antibiotic-associated diarrhea after H. pylori therapy.
✔️ There are descriptions, but no large studies have been carried out.
✔️Everyone is expected, because HP eradication includes at least 2 antibiotics, and even for 10-14 days.

However, look at the data from a retrospective cohort study (1994-2018) that included ❗️38,535 patients with detected ADR:
– 91.8% are men (Americans also like to do science for the military);
– the average age is 61.8 years;
– positive test for Clostridium difficile (it is this bacterium that causes antibiotic-associated diarrhea – CDI) within 3 months after detection of HP;
💡78.4% passed HP eradication;
💡Antibiotics used in HP eradication regimens – see carousel.
❗️ Only 0.74% had CDI.

Multivariate analysis showed the most significant relationship between CDI and:
❗️ a history of CDI;
❗️ and recent hospitalization (within 4 and 12 weeks).
❌HR therapy was not associated with CDI, although there was a weak association with successful eradication performed.
By the way, a weak connection was also found with smoking.

But additional results are interesting:
Those who developed CDI were less likely to take amoxicillin or clarithromycin regimen, but no such data were available for metronidazole and levofloxacin.
“PPI selection was also not associated with CDI (assess which is the most commonly prescribed PPI”).
On the basis of these data, the authors propose to think about whether it is necessary to carry out eradication for a patient who has been hospitalized (or was recently), but, fortunately, do not make it into the recommendations.

The authors also write about the restrictions:
✔️This is still a retrospective study.
✔️ Information from the largest database was evaluated, but it is possible that it is incomplete.
✔️No information about # PPI therapy outside the course of eradication.
And from myself I will note:
❗️ The percentage of compliance to the eradication scheme is not indicated, and the Clostridium difficile test included not only the determination of toxins, but also the PCR method.

Groups of contraceptives for women

Pharmacological market currently offers a wide range of drugs for contraception. All of them are divided into the following groups:

Combined oral contraceptives for example https://pillintrip.com/medicine/swingo – has hormones similar to the action of estrogen, these are progestogen and ethinyl estradiol. They distinguish preparations of biphasic, triphasic and monophasic.

Mini-pills. They contain only progestagen. The principle of action is a local influence on the peripheral zones of the reproductive organs. As a consequence of taking these drugs, a change in the biochemical and morphological indicators of the endometrium is noted, so the development of the fetus does not occur. In most women, the process of ovulation is suppressed. Effective representatives: Microlute, Lactinet, Exluton, Charosette.

OCs are divided into 3 groups based on the content of the active ingredient in the pills:

Monophasic – have low levels of hormones in the composition. Therefore, they are recommended for use by young girls who have not given birth before. And persons who have encountered birth control for the first time, such drugs will be the most suitable.

Biphasic – prescribed to young and middle-aged women, especially relevant in the postpartum period. Such pills should be taken by those who have a discharge on the background of taking microdose contraceptives. These drugs have anti-androgenic action, so have a positive effect on the skin and prevent unwanted hair growth. They include: Regulon, Marvelon, Silhouette.

Three-phase pills are characterized by a high content of female hormones. They are prescribed for some gynecological diseases and to restore the hormonal background. Representatives: Triquilar, Ovidon, Triseston.

How to choose the right birth control pills
In no case, it is not recommended to choose and start a course of taking birth control pills on your own. This should only be done by a doctor.

A specialist, before appointing a method of contraception collects the patient’s medical history, takes into account the presence of any diseases in the present or future and pays attention to the individual characteristics of the body.

The next step is a full examination of the woman, the doctor evaluates the constitution, body weight, skin condition and blood pressure. In addition, he prescribes instrumental and laboratory tests, especially important is an ultrasound, mammography.

Also, when choosing contraceptives, it is obligatory to take into account:

Breasts, its shape and structure.

Type of hairiness on the genitals.


The state of health of the skin and hair.

Features of the course of periods.

The presence of chronic diseases.


Cough is one of the most common symptoms that almost everyone has experienced. However, many people, without realizing the whole situation, approach the fight against cough incorrectly, aggravating their condition and delaying the start of necessary treatment. Sometimes it helps with a cough: https://pillintrip.com/medicine/neo-codion.

What is a cough?
Cough is a reflex reaction, a strong exhalation through the mouth, provoked by irritation of the receptors located in the mucous membrane of the respiratory tract. The role of coughing is to clear the respiratory system of foreign substances or objects that prevent air from entering the lungs.

Mechanism of development
Coughing is an innate unconditioned protective reflex. This means that if necessary, it arises on its own, independent of the will of the person and is realized from the moment of birth. But the cough can also be expressed voluntarily.

The act of coughing is provoked by mechanical irritation of the receptors that are located in the mucous membranes of all the organs that form the airways. The cough can also be caused by chemical effects on the receptors that are located in the internal organs and structures: stomach, diaphragm, pericardium, etc. The nerve impulse received from the receptors goes to the medulla oblongata, where the so-called “cough center” is located, which triggers the reflex.

The act of coughing begins with a short, deep breath. It is necessary to obtain a sufficient volume of air for a forced, sharp exhalation. At the end of such an inhalation there is a contraction of the muscles of the larynx and vocal cords, muscle fibers in the walls of the bronchi.

But at the height of inhalation there is a contraction of the respiratory muscles and muscles of the abdominal wall. Because of this, there is a sharp increase in pressure in the chest cavity. Then the vocal folds open, allowing air to escape from the lungs at high velocity and capture the contents of the airways with it.

Coughing comes in many forms. A number of diseases are characterized by separate forms of cough, recognizing which can greatly simplify the process of diagnosis.

Coughs are classified according to the following parameters:

By intensity: coughing, light and strong.
According to the presence of sputum: non-productive or dry, productive or wet.
According to the time of occurrence – morning, afternoon, evening, night.
Duration: episodic, short-term or episodic and continuous.
Duration: acute – up to 3 weeks, subacute – from 3 to 8 weeks, and chronic – more than 8 weeks.


Indications for use

Bacterial infections caused by susceptible pathogens: Upper respiratory tract infections (bronchitis, pneumonia, pleural empyema, lung abscess), ENT organ infections (sinusitis, tonsillitis, otitis media), biliary tract infections (cholangitis, Cholecystitis), intestinal infections (dysentery, salmonellosis, salmonella carrier), infections of the urogenital system and the pelvic organs (pyelonephritis, pyelitis, cystitis, Urethritis, prostatitis, cervicitis, salpingitis, salpingo-oophoritis, tuboovarian abscess, endometritis, bacterial vaginitis, septic abortion, postnatal sepsis, penile peritonitis, soft chancre, gonorrhea), skin and soft tissue infections (rye, impetigo, secondary infected dermatoses, abscess, phlegmon, wound infection), osteomyelitis, endocarditis, meningitis, sepsis; peritonitis, postoperative infections, prevention of infections in surgery. Amoklavin Bid indications. An indication is a term used for the list of condition or symptom or illness for which the medicine is prescribed or used by the patient. For example, acetaminophen or paracetamol is used for fever by the patient, or the doctor prescribes it for a headache or body pains. Now fever, headache and body pains are the indications of paracetamol.

Active ingredient, group

Amoxicillin+Clavulanic acid, Antibiotic, semisynthetic penicillin+beta-lactamase inhibitor

Dosage form

Lyophilisate for preparation of solution for intravenous injection, powder for preparation of drops for oral administration [for children] with concentration, powder for preparation of solution for intravenous injection, powder for preparation of suspension for p.


Hypersensitivity (including to cephalosporins and other beta-lactam antibiotics), infectious mononucleosis (including the appearance of a skin-like rash). Pregnancy, lactation, severe hepatic insufficiency, gastrointestinal diseases (including colitis in the history associated with the use of penicillins), CPP.

How to use: dosage and course of treatment

Oral (doses are given in terms of amoxicillin), the dosing regimen is established individually depending on the severity of the course and localization of the infection, the sensitivity of the pathogen. Adults and adolescents over 12 years are prescribed 250 mg three times a day. In severe course of infections, 500 mg 3 times a day or 1 g 2 times a day.

Children under 12 years of age are prescribed in the form of suspension, syrup or drops for oral administration 3 times a day. The single dose is adjusted according to age: for children aged 7-12 years – 250 mg, 2-7 years – 125 mg, 9 months-2 years – 62.5 mg, the frequency of prescription – 3 times a day. In severe cases, doses may be doubled. Oral doses for children 9 months-2 years of age – 20-40 mg/kg/day in 3 doses, for children 2-12 years – 20-50 mg/kg/day in 3 doses, depending on the severity of the infection.

For children under 9 months of age, the dosage for oral administration has not been established. When preparing suspension, syrup and drops, water should be used as a solvent.

When administered by injection in adults and adolescents over 12 years old 1.2 g 3 times daily, if necessary – 4 times daily. Maximum daily dose is 6 g. For children aged 3 months to 12 years, 25 mg/kg (30 mg/kg for the entire drug) 3 times a day; in severe cases – 4 times a day; for children under 3 months: premature and in the perinatal period – 30 mg/kg 2 times a day, in the post-perinatal period – 25 mg/kg 3 times a day.

The duration of treatment is up to 14 days.

For prevention of postoperative infections during surgeries lasting less than 1 hour, during anesthesia a dose of 1.2 g is administered v/v. In case of longer operations 1.2 g every 6 hours during the day. If there is a high risk of infection, administration may be continued for several days.

In CKD, the number of injections is reduced depending on the CK rate. In case of CKD more than 30 ml/min there is no need to reduce the dose; in case of 10-30 ml/min the treatment is started with 1.2 g by IV, then 600 mg by IV or 250-500 mg orally twice a day; in case of KKD less than 10 ml/min – 1.2 g, then 600 mg/day by IV or 250-500 mg/day orally in one course. For children, doses should be reduced in the same manner.

Hemodialysis reduces serum concentrations; therefore, during and at the end of dialysis, an additional 500 mg v/v is administered.

Pharmacological action

Amoklavin Bid indications. An indication is a term used for the list
Amoklavin Bid indications. An indication is a term used for the list

Pharmacological deaCombination of amoxicillin and clavulanic acid – beta-lactamase inhibitor. It acts bactericidally, inhibits the synthesis of the bacterial wall.

Active against aerobic gram-positive bacteria (including strains producing beta-lactamases): Staphylococcus aureus, Staphylococcus epidermidis, Streptococcus pyogenes, Streptococcus anthracis, Streptococcus pneumoniae, Streptococcus viridans, Enterococcus faecalis, Corynebacterium spp, Listeria monocytogenes; anaerobic gram-positive bacteria: Clostridium spp., Peptococcus spp., Peptostreptococcus spp;

aerobic gram-negative bacteria (including beta-lactamase-producing strains): Escherichia coli, Proteus mirabilis, Proteus vulgaris, Klebsiella spp., Salmonella spp., Shigella spp, Bordetella pertussis, Yersinia enterocolitica, Gardnerella vaginalis, Neisseria meningitidis, Neisseria gonorrhoeae, Moraxella catarrhalis, Haemophilus influenzae, Haemophilus ducreyi, Yersinia multocida (previously Pasteurella), Campylobacter jejuni;

anaerobic gram-negative bacteria (including beta-lactamase-producing strains): Bacteroides spp.

Clavulanic acid inhibits types II, III, IV and V beta-lactamases, it is inactive against type I beta-lactamases produced by Enterobacter spp., Pseudomonas aeruginosa, Serratia spp., Acinetobacter spp. Clavulanic acid has a high tropism to penicillinases, due to which it forms a stable complex with the enzyme, which prevents enzymatic degradation of amoxicillin under the influence of beta-lactamases.

Side effects

Digestive system: nausea, vomiting, diarrhea, liver dysfunction, increased liver transaminase activity, in single cases – cholestatic jaundice, hepatitis, pseudomembranous colitis.

Allergic reactions: urticaria, erythematous rash, rarely – erythema multiforme, anaphylactic shock, angioedema, very rare – exfoliative dermatitis, erythema malignant exudative (Stevens-Johnson syndrome).

Local reactions: in some cases – phlebitis at the site of intravenous injection.

Others: candidiasis, development of superinfection, reversible increase in prothrombin time. Symptoms: abnormal gastrointestinal function and water-electrolyte balance.

Treatment: symptomatic. Hemodialysis is effective.

Special Directions

During the course of treatment it is necessary to monitor the hematopoietic, hepatic and renal function.

In order to reduce the risk of gastrointestinal side effects, the drug should be taken with food.

Superinfection may develop due to growth of microflora insensitive to it, which requires appropriate changes in antibiotic therapy.

When administered to patients with sepsis, bacteriolysis reaction (Jarisch-Herxheimer reaction) may develop.

In patients with hypersensitivity to penicillins, cross-allergic reactions with cephalosporin antibiotics are possible.

Since tablets – combinations of amoxicillin and clavulanic acid of 250 and 500 mg contain the same amount of clavulanic acid (125 mg), 2 tablets of 250 mg are not equivalent to 1 tablet of 500 mg.

Once your health has been restored, it will be nice to refurbish your furniture. You can do this here:


Description of the drug farmapram (alprazolam)

Despite the widespread perception that there is a risk of drug dependence, data from numerous studies indicate that the frequency of dependence among patients receiving farmapram is relatively low. The authors note that addiction to benzodiazepines is relatively rare and occurs mainly in alcohol or drug abusers.

Description of the drug farmapram (alprazolam)

Some other side effects of alprazolam should also be mentioned. A number of studies have revealed deterioration of perception and reproduction of new information. This peculiarity should be taken into account when driving a car. It is important to note the interaction of farmapram (alprazolam) with alcohol, because many patients with anxiety symptoms resort to taking alcohol on their own to alleviate their condition. Their combined use leads to a significant worsening of the results of psychological tests and in some patients increases aggression and irritability.

Thus, as numerous data, including recent ones, show, alprazolam remains a fairly popular and effective tranquilizer. However, many issues require clarification and additional study. There are data indicating the effectiveness of alprazolam in the therapy of premenstrual syndrome. Successful use of alprazolam in treatment of acute stress and obsessive-compulsive disorders has been described. The drug was prescribed either at the beginning of a course in addition to selective serotonin reuptake inhibitors (SSRIs) to relieve severe anxiety, or as monotherapy for resistance or intolerance to SSRIs. However, despite the assumptions made, alprazolam has proven ineffective in the treatment of post-traumatic stress disorder (PTSD).

Description of the drug farmapram (alprazolam)

There is evidence for the use of alprazolam as a corrector of extrapyramidal symptoms (especially acute dystonia and akathisia) caused by neuroleptic intake. However, in the presence of other highly effective remedies for neuroleptic syndrome, alprazolam cannot be considered as a first-line drug. The most frequent side effects of alprazolam therapy are sedation and somnolence, which is explained by the interaction of the drug with GABAA-receptors and during the course of treatment, the above mentioned side effects are significantly reduced.

Discontinuation of regular alprazolam should be done gradually to avoid the development of withdrawal syndrome. Over such a period, lasting from several weeks to months, the daily dosage of the drug is gradually reduced until complete withdrawal. A number of studies have noted that reducing the dose of benzodiazepine tranquilizers may be accompanied by withdrawal syndrome and a return of clinical manifestations of the underlying disease, especially when therapy is abruptly discontinued.

Children’s health in the digital age

Today, psychologists are unanimous in the opinion that digital technology has a huge impact on the child. Whether we like it or not, modern technologies completely violate our usual ideas about the world around us.

While parents argue about how mobile devices affect the social, emotional and physical spheres of children, children themselves can no longer imagine their life without these devices. Psychologists, in turn, are thinking about how to use this influence of mobile devices for child development.

Most researchers agree that there are advantages and disadvantages to using smartphones by children, and at the same time, they argue about how digital technologies can change the lives of future generations. Despite this, scientists identify several ways to preserve the physical and mental health of children in the digital age. Let’s consider them in more detail.

Limit the time your child uses a cell phone

Children's health in the digital age

When parents manage their child’s mobile phone time, they help them find healthier activities for themselves. This is how children achieve a balance between the use of technology and real relationships with people.

Encourage physical activity

Excessive time that a child spends in front of a computer or smartphone screen leads to lack of physical activity, excess weight and other negative consequences. Encourage your child to devote more time to physical activities.

Pay attention to your child’s mental health

Psychologists see a link between the popularity of social media and mobile technology and the growing rates of depression, anxiety, and suicide attempts. Parents who are aware of the symptoms of mental illness and childhood trauma can help their child more quickly when needed.

Teach your child to cope with stress

The biggest problems come not from digital technologies themselves, but from the fact that they put a lot of pressure on children and greatly accelerate the pace of their lives. The use of social networks leads to the fact that children are always available for communication with peers and compare themselves with others. When parents teach their child meditation techniques and other ways to reduce stress, they can improve their mental health and overall well-being.

Encourage your child to communicate more with friends

It is easy to think that social media enhances the child’s communication and friendships with peers. However, a sense of loneliness is growing among children and adolescents today. Parents should involve their children in mass activities that will provide the child with interaction with peers.

Explore Online Health Resources

Children's health in the digital age

There is a wealth of information available on the Internet today about a child’s physical and mental health. Using them, you can investigate the symptoms of anxiety or depression in your child and learn how to prevent these disorders.

Use smartphone apps

There are smartphone apps that can help parents and children maintain a healthy lifestyle. Children can exchange these applications with each other, complicate tasks for themselves, etc.

Establish rules for the child before bedtime

Research is finding more and more evidence that using cell phones in the bedroom will shorten their sleep time. However, sleep is essential for children. Set rules for the whole family: for example, leave cell phones in a specific area outside the bedroom.

Tell your child how to distract from the cell phone and stay safe.

When a person uses a cell phone, it distracts his attention from other things. For example, if a teenager is distracted by the phone while driving, it will significantly increase the risk of an accident. Children need to understand that their health and safety is more important than talking on the phone.

How to strengthen the child’s immunity with folk remedies: proven tips and recipes

On the eve of cold weather, an urgent question for many parents is how to strengthen the child’s immunity with folk remedies so as not to resort to expensive medications and at the same time ensure the safety of the baby. In fact, this is a really important problem, since immunity is responsible for susceptibility to all diseases, not just influenza and SARS. With a reduced immune defense, it is more difficult for a child to resist even the simplest bacterial and fungal infections, not to mention more complex diseases that can cause various disorders and complications in the body.

Depletion of immunity in children is, perhaps, a common problem for many parents. Someone blames bad ecology and a high level of stress for this, for others the source of reduced immunity is a lack of understanding of the principles of proper baby nutrition, non-compliance with sleep and rest, while others find justification in previous illnesses.

How to strengthen the child's immunity with folk remedies: proven tips and recipes

Indeed, the reasons for the decrease in the body’s immune defenses can be different. Here the immaturity of the immunity itself in children also affects, since it “matures” not in a year or two, but “learns” to recognize dangers and give a proper response to them throughout life. It is not surprising that the beginning of attending kindergarten or school is often accompanied by colds in young children, and this has even become a kind of norm.

In conditions when the baby has a decrease in immunity, the main thing that parents need to do is not to give up and not let the situation take its course. On the contrary, in this case, it is recommended to mobilize as much as possible and try to find affordable, effective and simple means that strengthen the immunity of children of any age.
How to strengthen a child’s immunity after illness
The need to support children’s immunity often arises after the baby has had the flu or ARVI. To prevent re-infection, parents should provide additional care for the child’s immunity. In this case, some doctors recommend an affordable and simple drug that is suitable even for newborns and children in the first months of life – Derinat drops. They not only help restore immunity, but are also able to fight directly against viruses. In addition, Derinat drops strengthen the mucous membrane of the nasopharynx, improving its barrier properties, thereby helping to prevent the penetration of pathogens into the child’s body and avoid infection. Read more about the drug on our website.

How to strengthen the child's immunity with folk remedies: proven tips and recipes

In addition to Derinat drops, you can use a variety of herbal decoctions. This is a good and inexpensive option for how to strengthen the immunity of children with folk remedies. You can use the following recipes:

Tea made from St. John’s wort, chamomile, immortelle and birch buds. All components must be taken in equal proportions, filled with boiling water in a thermos and left overnight. Strain the ready-made composition and give the child half a glass once a day half an hour before meals.
Lingonberry tea. It is prepared on the basis of lingonberry leaves with the addition of dried berries. Drink freshly brewed throughout the day.
Rowan tea. It is prepared on the basis of dried rowan berries, raspberries and currant leaves (ratio 1: 1: 3). All ingredients must be poured with boiling water and insisted for about 10 minutes, add sugar or honey and drink in small portions throughout the day.

Denis Slinkin

Fasting Blood Sugar

It’s important that your body has enough fuel, especially with your routine. Insufficient energy for fuel sends stress signals to your body, which tend to raise glucose levels, says Denis doctor. The next question is how intense your training is – if it’s very intense, adrenaline is released and that will raise glucose levels.

An interesting experiment would be to check before and after a mild, moderate and intensive workout to see if it’s the intensity that causes the level to rise, says Dr. Slinkin.

Another experiment would be to play with your breakfast FBS in advance, first making sure you’re eating breakfast and then perhaps changing what you’re eating to include more or less healthy carbohydrates and protein. It’s hard to understand what causes them because there are so many factors to consider – diet, sleep, stress, exercise, along with your individual metabolic state. If you are really struggling, I would recommend that you meet with a diabetes teacher or doctor that you trust to discuss your particular situation. 

FBS Denis Slinkin

They may suggest changing your medication or time. But in short, maintaining a healthy weight, regular physical activity and a balanced low-carbon diet are some of the best habits in life to take these levels under control and prevent/slacken the progression of diabetes.
What if the number of hungry people is higher than the night before?

Again, I would suggest discussing your specific situation with a trusted professional. That depends on how higher they are than the night before… and how high they were at night. For example, FBS if there were 250 (13.8) in the morning and 170 (9.4) the night before, then you should consider both of these numbers because they are both higher than normal.
On the other hand, if they are within reach of the night before but elevated in the morning, there are various options to study, most of which have already been mentioned above. But then again, it will always depend on many factors – if you wake up with 140s (7,8s), it is much different from waking up with 350s (19s).

The best advice is to focus on making the right lifestyle changes (see above and on our blog!) and seek medical help from the rest of us, says Slinkin.