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For how long to take PPI after finishing antibiotic

The most popular treatments consist of two antibiotics (one of which is usually clarithromycin) plus a strong acid blocker such as omeprazole (PriLosec, Nexium, Somac, Zoton, etc.). Treatment is for 7-10 days. Cure rate is about 85%

Moderators: Toni, barjammar, luci2010, Ondek-Expert, kkimura

cookieMONSTER
Posts: 2
Joined: Mon Jul 23, 2018 5:34 am

For how long to take PPI after finishing antibiotic

Post by cookieMONSTER »

Hi,

I am currently on the 3 day of the triple therapy (also taking 1 sachet VSL# along the treatment). I am supposed to take the antibiotics for 8 days and then go on taking the PPI "until finishing the box", that means 40 days longer (half dosage).
The problem is I feel my digestion was already really weak (hence the diagnosis/treatment) and now, after starting the treatment it got even worse... I can barely eat without feeling a pain on the lower left side and, mostly after lunch, really lethargic. All this even though I make small light meals.

My question is, do I really need to go on taking the PPI for so long after finishing the antibiotics? I think the difficult digestion could be related to the actual reduction of stomach acid.

What's the usual duration for PPI? I am not supposed to have ulcers, at least they were never diagnosed.

Thank you!

Helico_expert
Site Admin
Posts: 4100
Joined: Wed Mar 02, 2011 7:20 am

Re: For how long to take PPI after finishing antibiotic

Post by Helico_expert »

you only need to take PPI for that long if you are diagnosed with ulcer. otherwise, you can stop together with the antibiotics.

however, it is important to know that antibiotics work best in less acid condition. So the more PPI you take now (2x dose), the higher the cure rate.

cookieMONSTER
Posts: 2
Joined: Mon Jul 23, 2018 5:34 am

Re: For how long to take PPI after finishing antibiotic

Post by cookieMONSTER »

Thank you for answering.

Two more questions: is it possible the pains are caused by the antibiotic itself? I am taking both of them together with the PPI before meals. Is any of the antibiotics (Clarythromicin and Amoxicilin) known to cause pain? Should I take any of them after meals instead of in an empty stomach?

Also, if I go on taking the PPI after finishing the antibiotics would it help to recover any possible damage made by H. Pylori to the stomach wall?

Helico_expert
Site Admin
Posts: 4100
Joined: Wed Mar 02, 2011 7:20 am

Re: For how long to take PPI after finishing antibiotic

Post by Helico_expert »

although the protocol says to take the antibiotics before meal. but we have not shown difference if taken after meal. So, it's up to you. Whichever suit you better.

unfortunately, the pain could be anything. It's not good to assume anything without a proper endoscopy examination or ultrasound scan. But, if the pain is tolerable, just try ignore it and finish the course.

AMERC
Posts: 42
Joined: Mon Dec 07, 2020 5:23 am

Re: For how long to take PPI after finishing antibiotic

Post by AMERC »

Hi Helico Expert

I completed my triple therapy 7 day course of Amoxicillin (1g), Clariythomicine (500mg) and Pantoprazole (40mg) twice a day end of October. Although the endoscopy did not show any ulcer or inflammation the biopsy showed H Pylori.

The GP did not say anything about how long to continue with PPI but as I had omeprazole 20mg I continued with this for another 2 weeks but then went down to 10mg for the next 3 weeks hoping to stop completely to do a retest to see if it has cleared. Acidity has really increased since last week and I am back on 20mg once daily. Now my GP say I should increase it 20mg twice a day. Because of this I have not been able to do a retest.

My questions are:

1. Usually for how long do people take PPI after completing the course and at what dosage?
2. Do I really need a higher PPI dose if no inflammation was found (although I find this hard to believe)? The higher the dose the more difficult to wean off before retesting.
3. Could the return of symptoms be because the strong the antibiotics have destroyed the good bacteria although it now over 6 weeks since ending the course?

Plotun
Posts: 56
Joined: Sun Sep 27, 2020 2:48 am

Re: For how long to take PPI after finishing antibiotic

Post by Plotun »

AMERC wrote:
Tue Dec 15, 2020 9:34 pm
Hi Helico Expert

I completed my triple therapy 7 day course of Amoxicillin (1g), Clariythomicine (500mg) and Pantoprazole (40mg) twice a day end of October. Although the endoscopy did not show any ulcer or inflammation the biopsy showed H Pylori.

The GP did not say anything about how long to continue with PPI but as I had omeprazole 20mg I continued with this for another 2 weeks but then went down to 10mg for the next 3 weeks hoping to stop completely to do a retest to see if it has cleared. Acidity has really increased since last week and I am back on 20mg once daily. Now my GP say I should increase it 20mg twice a day. Because of this I have not been able to do a retest.

My questions are:

1. Usually for how long do people take PPI after completing the course and at what dosage?
2. Do I really need a higher PPI dose if no inflammation was found (although I find this hard to believe)? The higher the dose the more difficult to wean off before retesting.
3. Could the return of symptoms be because the strong the antibiotics have destroyed the good bacteria although it now over 6 weeks since ending the course?
When I did endoscopy in July, my GP said that I should take PPI for 2 months, although endoscopy didn't show ulcers, only antral gastritis and bulbitis. I didn't want to take PPI for so long period. I've discontinued it after 3 weeks.

AMERC
Posts: 42
Joined: Mon Dec 07, 2020 5:23 am

Re: For how long to take PPI after finishing antibiotic

Post by AMERC »

What was your dosage and did you stop cold turkey.

My symptoms have been very intense off late despite moving back to 20mg omeprazole after bring on 10mg for 3 weeks. Not sure it a kind of acid rebound effect

Plotun
Posts: 56
Joined: Sun Sep 27, 2020 2:48 am

Re: For how long to take PPI after finishing antibiotic

Post by Plotun »

40 mg Pantoprazole, once daily. I switched to famotidine, 40 mg daily. But my case is more severe than yours, I have been misdiagnosed for about a year until I had proper diagnose, so my stomach went mad in that period. I thought that I"ve developed ulcers, but it was just gastritis and bulbitis and H.Pylori.

I don"t get it how do you feel these symptoms if your endoscopy didn"t show any inflammation, it"s weird.

Helico_expert
Site Admin
Posts: 4100
Joined: Wed Mar 02, 2011 7:20 am

Re: For how long to take PPI after finishing antibiotic

Post by Helico_expert »

You can try switch to famotidine, a shorter life span acid blocker. You can continue to take famotidine until the night before breath test.

the PPI is really to prevent the acid from burning your stomach skin.

normally your stomach skin will produce a layer of mucus layer to prevent the acid from burning.
but the inflammation (or NSAIDs) can reduce the mucus secretion.

So while your stomach is healing, with the hope that the mucus secretion can be restored (normally will), you just need to take PPI.

For some rare cases, such as metaplasia patients, the mucus secretion cannot be restored. Then you'll have to rely on PPI for a long period of time.

AMERC
Posts: 42
Joined: Mon Dec 07, 2020 5:23 am

Re: For how long to take PPI after finishing antibiotic

Post by AMERC »

The problem is we don't get any H2 blockers in the UK. Only antacids like Gaviscon

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