How do you think about this second treatment?
Posted: Sat Sep 01, 2018 11:30 am
First of all, thank you for your comment in advance. I’m glad that I found a place where I can get opinions from several experts.
I’m just about to begin my second treatment for Helicobacter Pylori. I already have prescribed drugs in my hand, but I’d like to check if this prescription seems appropriate. Of course, the drugs were prescribed by a gastroenterologist. However, I’m curious how the members in this professional forum think about.
Some Background: I’m from South Korea where Helicobacter Pylori is very prevalent. (It’s so prevalent such that Prof. Marshall starred in a probiotics yogurt advertisement.) Here is a record of my stomach examinations.
2012: Had EGD for the first time with Doctor A. Diagnosed with chronic superficial gastritis. Biopsy was done and diagnosed with h. pylori. Since chronic superficial gastritis and h. pylori are common in S. Korea, the doctor didn’t consider them to be problematic. She said she had chronic superficial gastritis too.
2013: Had EGD with Doctor B. Asked the doctor not to do a biopsy as I already knew I had h. pylori. Diagnosed with chronic superficial gastritis as expected.
2014: Had EGD with Doctor C. I told him that I have h. pylori and he told me that it should be treated as it does no good to my health at all. He did a biopsy to verify that I have h. pylori and prescribed the following drugs for the first treatment.
Rabeprazole Sodium 20 mg - 2 times per day for 10 days
Clarithromycin 500 mg - 2 times per day for 10 days
Amoxicillin 1000 mg - 2 times per day for 10 days
2015: Had EGD with Doctor D. Asked him to do a biopsy to see if h. pylori had been eradicated. H. pylori was still there, but this doctor advised me to save the second treatment for serious stomach condition such as ulcer. He was concerned that if the second treatment fails and h. pylori develops resistance against antibiotics, I would have difficulty in case I get a stomach ulcer or something else.
As a side note, National Health Insurance Service of S. Korea does not recommend nor reimburse treatment for h. pylori unless the patient has certain stomach conditions. For this reason, Korean doctors are divided between whether h. pylori has to be always treated or not.
2016: Had EGD with Doctor E. No biopsy done. Diagnosed superficial gastritis as usual.
2017: Had EGD with Doctor F. No biopsy done. Diagnosed with atrophic gastritis and acid reflux. Given that I’m in early 30s, having atrophic gastritis certainly sounds bad. Nevertheless, the doctor just told me to get EGD annually.
2018: Had EGD with Doctor C again. He told me that I had severe inflammations in the stomach. (I had heartburn and back pain, so it was not surprising.) He said my stomach was in transition from superficial gastritis to atrophic gastritis. Biopsy was done to verify that I had h. pylori and he prescribed the following drugs for the second treatment.
Rabeprazole Sodium 20 mg - 2 times per day for 10 days
Tripotassium Bismuth Dicitrate 300 mg - 4 times per day for 10 days
Tetracycline HCl 500 mg - 4 times per day for 10 days
Metronidazole 500 mg - 3 times per day for 10 days
My dad was with me when Doctor C was telling me about the second treatment and he asked the doctor if 10 days was good enough. (He asked because his second h. pylori treatment was successful with 14 days of prescription.) The doctor answered that there is a negligible difference of cure rate between 10-day prescription and 14-day prescription and the doc just gave me a 10-day prescription.
My primary question is does this prescription look appropriate for a standard second treatment? I didn’t have antibiotic sensitivity testing, so I’m just asking in general. I don’t want to take insufficient drugs that may develop antibiotic resistance of h. pylori eventually.
I asked Doctor C if there is backup therapy in case this second treatment fails, and he answered there is. But I guess there is only a limited number of backup therapies remaining as h. pylori will become more resistant against antibiotics. If it were not for the risk of developing antibiotic resistance of h. pylori, I would have started the second treatment a long time ago. Frequent heartburn and occasional back pain are quite irritating.
If that second prescription does not seem adequate, I’ll see another doctor to get a different prescription based on what experts comment here.
I’m just about to begin my second treatment for Helicobacter Pylori. I already have prescribed drugs in my hand, but I’d like to check if this prescription seems appropriate. Of course, the drugs were prescribed by a gastroenterologist. However, I’m curious how the members in this professional forum think about.
Some Background: I’m from South Korea where Helicobacter Pylori is very prevalent. (It’s so prevalent such that Prof. Marshall starred in a probiotics yogurt advertisement.) Here is a record of my stomach examinations.
2012: Had EGD for the first time with Doctor A. Diagnosed with chronic superficial gastritis. Biopsy was done and diagnosed with h. pylori. Since chronic superficial gastritis and h. pylori are common in S. Korea, the doctor didn’t consider them to be problematic. She said she had chronic superficial gastritis too.
2013: Had EGD with Doctor B. Asked the doctor not to do a biopsy as I already knew I had h. pylori. Diagnosed with chronic superficial gastritis as expected.
2014: Had EGD with Doctor C. I told him that I have h. pylori and he told me that it should be treated as it does no good to my health at all. He did a biopsy to verify that I have h. pylori and prescribed the following drugs for the first treatment.
Rabeprazole Sodium 20 mg - 2 times per day for 10 days
Clarithromycin 500 mg - 2 times per day for 10 days
Amoxicillin 1000 mg - 2 times per day for 10 days
2015: Had EGD with Doctor D. Asked him to do a biopsy to see if h. pylori had been eradicated. H. pylori was still there, but this doctor advised me to save the second treatment for serious stomach condition such as ulcer. He was concerned that if the second treatment fails and h. pylori develops resistance against antibiotics, I would have difficulty in case I get a stomach ulcer or something else.
As a side note, National Health Insurance Service of S. Korea does not recommend nor reimburse treatment for h. pylori unless the patient has certain stomach conditions. For this reason, Korean doctors are divided between whether h. pylori has to be always treated or not.
2016: Had EGD with Doctor E. No biopsy done. Diagnosed superficial gastritis as usual.
2017: Had EGD with Doctor F. No biopsy done. Diagnosed with atrophic gastritis and acid reflux. Given that I’m in early 30s, having atrophic gastritis certainly sounds bad. Nevertheless, the doctor just told me to get EGD annually.
2018: Had EGD with Doctor C again. He told me that I had severe inflammations in the stomach. (I had heartburn and back pain, so it was not surprising.) He said my stomach was in transition from superficial gastritis to atrophic gastritis. Biopsy was done to verify that I had h. pylori and he prescribed the following drugs for the second treatment.
Rabeprazole Sodium 20 mg - 2 times per day for 10 days
Tripotassium Bismuth Dicitrate 300 mg - 4 times per day for 10 days
Tetracycline HCl 500 mg - 4 times per day for 10 days
Metronidazole 500 mg - 3 times per day for 10 days
My dad was with me when Doctor C was telling me about the second treatment and he asked the doctor if 10 days was good enough. (He asked because his second h. pylori treatment was successful with 14 days of prescription.) The doctor answered that there is a negligible difference of cure rate between 10-day prescription and 14-day prescription and the doc just gave me a 10-day prescription.
My primary question is does this prescription look appropriate for a standard second treatment? I didn’t have antibiotic sensitivity testing, so I’m just asking in general. I don’t want to take insufficient drugs that may develop antibiotic resistance of h. pylori eventually.
I asked Doctor C if there is backup therapy in case this second treatment fails, and he answered there is. But I guess there is only a limited number of backup therapies remaining as h. pylori will become more resistant against antibiotics. If it were not for the risk of developing antibiotic resistance of h. pylori, I would have started the second treatment a long time ago. Frequent heartburn and occasional back pain are quite irritating.
If that second prescription does not seem adequate, I’ll see another doctor to get a different prescription based on what experts comment here.