Rescue treatment after metronidazole failure

[atomasca]

I am looking for advice about the best treatment regime following initial failure with 7 days of amoxicillin, metronidazole and lansoprazole. My doctor has prescribed quadruple therapy with omeprazole 20 mg bid, metronidazole 400 mg tid, tetracycline 500 mg qid and bismuth De-Nol 2 tablets bid for 14 days. I am not sure if this is the correct treatment given the previous failure with metronidazole. My previous treatment (in January) also gave me C Difficile colitis so my doctor is suggesting that I take vancomycin on top to prevent another bout of C Difficile. Any advice on whether I should take this or another treatment for H Pylori would be greatly appreciated.

[Helico_expert]

Bismuth + metronidazole + tetracycline is a good combination.

but omeprazole is not very strong. Perhaps you can ask for higher dose or different PPI, eg. rabeprazole 20mg TID.

Bismuth can also prevent C. difficile.

[atomasca]

Thank you for your answer. Would nexium/esomeprazole 40 mg bid be a better PPI? Also, would you still include metronidazole despite the previous failure? And is 400 mg metronizadole tid enough? I read that with metronizadole resistance you need at least 1500 mg per day for the treatment to work. Would it be better to take it at 400 mg qid for just 10 days? Many thanks

[Helico_expert]

Yup you are right about the high dose Metronidazole for resistance case. So you can ask your doctor about it.

There are also studies that showed that metronidazole resistance can be overcome when taken together with tetracycline. So you can still take it despite your previous treatment failure.

esomeprazole is better than omeprazole. So 40mg nexium TID is good.