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Advice for persistant H. pylori

Posted: Sun Nov 10, 2019 9:09 am
by connaki
I'm in Australia, 39, and was diagnosed with H.pylori for the past 6 months after developing bloating symptoms (I could be allergric to amoxacillin - had a small reaction when I was young - but I will now go and find out). The doctor initially put me on 20mg 2/day Esomeprazole, 400mg metronidazole 3/day and 400mg clarithromycin 2/day for 7 days. I did another breath test and it came back positive. Then 3 months ago the doctor put me on another treatment - this time 20mg 2/day Esomeprazole, 500mg cephalexin 2/day and 100mg doxycycline 2/day again for 7 days. I did another breath test 2 months ago and it was positive again. I only just finished taking another antibiotic course - this time 20mg 2/day Esomeprazole, 400mg clarithromycin 2/day and 400mg metronidazole 3/day - and am now waiting to be testing again.

The doctor who gave me the last regiment asked me if I REALLY wanted to get rid of it?? He said that there is so much antibiotic resistance (and that I could probably get it again) that its not worth it - especially because 20mg esomeprazole a day keeps me pretty well..

Don't you think that the doctor should be trying different antibiotics?? I tried telling him that but he didnt listen..

PS. I am definitely going to get tested for amoxicillin allergy, as I think I was probably misdiagnosed like a lot of others back in the 80s!

Re: Advice for persistant H. pylori

Posted: Sun Nov 10, 2019 9:39 am
by Helico_expert
agree that you should not be given clarithromycin and metronidazole again.

You can seek second opinion. see if anyone is willing to get you bismuth-based quadruple treatment.

Re: Advice for persistant H. pylori

Posted: Sun Nov 10, 2019 10:12 am
by connaki
Yes, I have also seen data that shows that metronidazole and clarithromycin have large resistance rates in Australia. I'm actually in the US (for work) and just bought a few bismuth tablets - do you recommend I tell my doctor to include these in my next attempt (given the latest attempt is likely to fail)?

Re: Advice for persistant H. pylori

Posted: Mon Nov 11, 2019 9:55 am
by Helico_expert
yes, you can certainly tell your doctor to include bismuth in your next trial.

the trick is to get very high dose PPI. you can also tell him that Prof. Marshall uses Rabeprazole 20mg 3x a day.

Nevertheless, it is better you get another breath test before treatment. Who knows you may be lucky and got rid of it.

Re: Advice for persistant H. pylori

Posted: Mon Nov 11, 2019 10:21 am
by connaki
Thanks for the advice - it is really appreciated!! I'll let you know if I got lucky - but I doubt it :)

As a biomedical researcher myself, I have been looking up this topic for the past 6 months - there's so much new research being conducted, and unfortunately I believe that the doctors dont usually have the most up-to-date research handy!

PS. And you are right about the high PPIs during treatment - all the latest literature points to better eradication with higher PPIs. I've also seen some promising recent research around Bismuth - hopefully the Australian guidelines change to make it more widely available!

Re: Advice for persistant H. pylori

Posted: Mon Nov 11, 2019 10:25 am
by Helico_expert
You are welcome. You know where (this forum) to find answer next time you have questions about H. pylori. :D

Re: Advice for persistant H. pylori

Posted: Mon Nov 11, 2019 10:27 am
by connaki
Yes - I really do appreciate your help with this - its good to know that we have access to a lab with the latest research on this.

I"ll let you know how I go in one months time!

Keep well :)

Re: Advice for persistant H. pylori

Posted: Wed Apr 01, 2020 6:46 pm
by connaki
Sorry I havent posted here for a while - been really busy!

Unfortunately the treatment with nexium, clarithromycin and metronidazole for 2 weeks did not work. The GP has referred me to a gastroenterologist, who finally advised that we try second line treatment i.e. bismuth, metronidazole, tetracycline and nexium. I asked if we could swap with metronidazole (as Ive taken it a few times before) with something like ciprofloxacin - but he got annoyed and said we will do this second line treatment first and then look at salvage therapies after.

Thoughts?

Re: Advice for persistant H. pylori

Posted: Thu Apr 02, 2020 10:26 am
by Helico_expert
yea.. your gastroenterologist should explain to you that metronidazole resistance can be overcome when used together with tetracycline.

i would give that a try as well. Perhaps you should also ask for higher dose nexium (eg. 20mg TID).

Re: Advice for persistant H. pylori

Posted: Wed Jul 01, 2020 3:10 pm
by connaki
This treatment has definitely has been a rollercoaster! After treatment with bismuth 105mg (4x daily), metronidazole 400mg (4xdaily), tetracycline 500mg (4x daily) and nexium 20mg (3x daily) for 2 weeks - I did a breath test which was 'inconclusive' - I finally had hope that I was negative,as previous breath tests have easily detected it! But no - I then did a stool test and it came back positive.....

The gastroenterologist has now said that he will be replacing the metronidazole with levofloxacin as a salvage therapy - any more advice moving forward?