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欧洲幽门螺杆菌治疗共识 5

Second theraphy failed next Quadruple T. need advise

After first line treatment, various "second line" treatments can be used. The policy for H.pylori is: Make sure the infection is real (breath test for follow-up). Always give a high dose of PPI (acid blocker) when using amoxicillin. In the second treatment, give a different drug in place of clarithromycin.

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Posts: 6
Joined: Wed May 15, 2019 4:40 am

Second theraphy failed next Quadruple T. need advise

Post by Litza1503 »

I was diagnosed with HP in Feb 2018 , Initial I had a 7 day treatment, few months after I had an endoscopy that show negative so I assumed I was cured.
This Feb 2019 exactly a year later I was tested again and It was positive , so my doctor gave me the same 1st treatment but this time for 14 days :
-Prevacid 30mg
-Clarithromycin 500mg
-Amoxiciling 500MG.

I finished the treatment at the beginning of March and I had a breath test 3 weeks ago which showed I will have HP. I don't have any symptoms, in fact I was almost sure I didn't have it because I feel pretty good , I eat everything no pain no reflux nothing... because of no symptoms I asked my Dr. to send me for a stool test to make sure the breathing test was correct and last week the results of the stool test showed positive for HP :o

I am start thinking that maybe I got resistance to the amoxicillin since I took it in different occasions for other reason, but my doctor told me that my next option is a quadruple therapy and this is what he is prescribing:
-Tetracycline 250Mg
-Metronidazole 500MG
-Rabeprazole 20mg
-Peptobismol in tables.
I believe it is twice a day, not sure because he told me the pharmacist will tell me how to take it. But I am terrify of taking this medication specially when I don't have symptoms and feel pretty healthy. is there a chance that the endoscopy missed the HP and I was never cure so it is not really a infected case?? Is this quadruple prescription a good option after failing triple therapy?
My husdand and daughter were tested and they are negative, meanwhile I am so paranoid about passing the HP onto them. I am also so concern about eating outside, washing my hands thousand of times a day and I don't know why I can't get rid off this horrible bacteria.
I would like to make sure I am taking a therapy with high chances of eradication, my doctor told me he never seen someone failing Triple T. so I am worried he doesn't have enough experience with re-infected or resistance treatment …..

Any advise would be really appreciated.

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Re: Second theraphy failed next Quadruple T. need advise

Post by Helico_expert »

I think it is better to have H. pylori eradicated even if you dont have symptoms. First it prevent you from spread to your family, and second, prevention is better than cure. Dont wait till you have symptoms, and by that time, it could be too late.

It is very rare for someone to catch H. pylori when the family is negative of H. pylori.

However, since both breath and stool test showed that you have H. pylori, it is most likely true.

Rabepraole + Bismuth + Metronidazole + Tetracycline is a very strong combination. If your doctor has not seen anyone failed triple therapy, then this treatment would work just fine. Nevertheless, you can ask your doctor for a less potent combination, eg. Rabeprazole + Bismuth + amoxicillin + Metronidazole

H. pylori cannot become resistant to amoxicillin and bismuth. So, you can always repeat these two drugs.

the key to have good cure rate is the high dose PPI and amoxicillin. Ask your doctor about:
rabeprazole 20mg 3 times a day
Amoxicillin 1g 3 times a day

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