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Re: RUT: positive or negative?

Posted: Tue May 26, 2020 11:55 pm
by Sajal
"Resistance to ppis"—I haven't heard about it. Does it mean that esomeprazole won't suppress acid secretion? As far as I know, esomeprazole very well work for me as far as suppressing stomach acid is concerned like any other ppis. Also, I have used rabeprazol(20mg tid) in my last round of abx(rifabutin+amoxicillin) but in vain.

I understand that ppis plays a vital role as strong inhibition of gastric acid secretion is crucial for h pylori eradication. Thing is, I have only tried second generation ppis i.e., rabeprazol and esomeprazole in all my eradication regimens so far. Should I try a first generation ppis such as Omeprazole, lansoprazole etc. this time?

I am aware that increasing the dose and number of pills of ppis improves the eradication rate though not significantly. What ppis should I try this time and what would be its 'very high dose'?

Also, I was wondering if 750mg amoxicillin qid would serve the purpose because in my last abx I have had used1g of amoxicillin tid ? Should I increase it to 1g qid this time?

Re: RUT: positive or negative?

Posted: Wed May 27, 2020 8:51 am
by Helico_expert
If you feel well after esomeprazole, then it's ok.
perhaps you should try find out if there is someone that can do antibiotic sensitivity testing? perhaps some of the medications that you have used before can be reused.

Re: RUT: positive or negative?

Posted: Wed May 27, 2020 2:13 pm
by Sajal
Unfortunately, in India antibiotics susceptibility test is not available. I guess I have try on my own.

What about the question I raised regarding the ppis in the last post?

Re: RUT: positive or negative?

Posted: Wed May 27, 2020 3:54 pm
by Helico_expert
you should avoid omeprazole.

stick to either esomeprazole or rabeprazole.

Re: RUT: positive or negative?

Posted: Sun May 31, 2020 8:01 pm
by Sajal
Will esomeprazole 20 mg qid be able to reach the required ph in stomach for amoxicillin to work?

Re: RUT: positive or negative?

Posted: Sun May 31, 2020 11:37 pm
by Helico_expert
Good question. I have not actually measure it myself. So I dont know. But 20mg is definitely a very high dose used in some studies.

Re: RUT: positive or negative?

Posted: Sun Sep 13, 2020 12:43 am
by Sajal
Here I am again with the same question: what abx should I try this time. Have had 4 round of abx–
-:(amox+clarithro+ppis)
-:(metro+tetra+amox+bismuth+ppis)
:-(amox+rifabutin+bismuth+ppis)
:-(amox750mg qid+bismuth+ esomeprazole 20mg qid)

The only antibiotic that I haven't tried and which is available in my country is levofloxacin. I want the best possible combination this time as I would left with no options after that. Thing is, I have used Amoxicillin every time in my previous abx therapies; I am suspicious that It doesn't work for me. Can I try levofloxacin with tetracycline this time? I have tried tetracycline once. What is the possibility of acquired resistance of tetracycline?

I cannot live with this bug. It is ruining my entire life. This is the most precious time of my life.

There is no antibiotic susceptibility test is available here in India. What can I do here? I am confused between amoxicillin and tetracycline.

Re: RUT: positive or negative?

Posted: Mon Sep 14, 2020 12:25 am
by Helico_expert
You can try rabeprazole 20mg TID

rabeprazole is probably a better PPI than others.

you can continue bismuth and amoxicillin as it's very hard for HP to become resistant to them.
you can also have levofloxacin if you can get hold of it.

so

Rabeprazole 20mg TID
bismuth 240mg QID
amoxicillin 1000mg TID
levofloxacin 250mg BID