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Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Tue Sep 10, 2019 4:09 am
by ankiwo72
chetanvenki wrote:
Mon Sep 09, 2019 9:20 pm

What does this sensitivity numbers mean, please eloberate on how much dosage of antibiotics would be susceptible with these numbers. I am due to get my susceptibility test result this week.
My understanding is that those numbers are the minimum amount of each antibiotic in micrograms the bacteria was susceptible to. In some cases the amount was too high to be considered an effective treatment option. Maybe the moderators can explain better?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Tue Sep 10, 2019 8:54 am
by Helico_expert
Minimum Inhibition Concentration (or MIC) is the right term for antibiotic resistance determination.

according to the EUCAST guideline.
Quinolones MIC is 1 mg/L <- eg. ciprofloxacin
Tetracyclines MIC is 1 mg/L
Metronidazole MIC is 8 mg/L
Rifampicin MIC is 1 mg/L

according to the CLSI guideline.
Macrolides MIC is 1 mg/L <- eg. Clarithromycin

Although Amoxicillin MIC is set to be 0.125 mg/L, we think it should be 1 mg/L

If your H. pylori strain has a tolerance of these antibiotics greater than the listed MIC, then it is considered as resistant strain.
However, factors that may affect the MIC include
1. the methods of exposure of the antibiotics to the microorganism;
2. the brand (or purity) of the antibiotics; and
3. the technician handling the results.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Thu Nov 21, 2019 11:50 pm
by ankiwo72
My last test result just came in and result showed (as moderator predicted) the last treatment failed. I think I miscounted treatments and that was actually the 6th treatment (not 7th).

I am scheduled for endoscopy/colonoscopy on Tuesday next week. I have requested blood tests (CBC and iron panel) and abx susceptibility testing again.

Is there anything else I should ask the doctor to do? Is testing the bacteria for CagA or VacA helpful in any way to determine virulence/pathogenicity? What would the name of the test be called for that and would this be at all useful for the doctor to help guide treatment?

Thank you!

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Sat Nov 23, 2019 5:59 am
by Dignity
I was tested H P but I have been taking lansoprazole capsule, Tinidazole and clarithromycin and am still feeling the same way. Pls what can I do

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Sun Nov 24, 2019 9:01 am
by Helico_expert
I assumed you meant you were tested positive with UBT

then you were prescribed lansoprazole, tinidazole, and clarithromycin

Then you completed the 14 days treatment and your symptoms are still there.

In that case, you need to repeat your breath test in one month time.

Meanwhile, stop taking lansoprazole. you can take ranitidine until the night before breath test. We shall continue this discussion then.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Sun Nov 24, 2019 12:10 pm
by ankiwo72
ankiwo72 wrote:
Thu Nov 21, 2019 11:50 pm
My last test result just came in and result showed (as moderator predicted) the last treatment failed. I think I miscounted treatments and that was actually the 6th treatment (not 7th).

I am scheduled for endoscopy/colonoscopy on Tuesday next week. I have requested blood tests (CBC and iron panel) and abx susceptibility testing again.

Is there anything else I should ask the doctor to do? Is testing the bacteria for CagA or VacA helpful in any way to determine virulence/pathogenicity? What would the name of the test be called for that and would this be at all useful for the doctor to help guide treatment?

Thank you!
Hi Moderator,

I am hoping you can respond to my question too. I just got result back from breath test and still positive. Last treatment was 30 days amoxicillin 3000mg/day plus 20mg omeprazole 3x/day (we had previous discussions on this), but that is not important now. If my endoscopy shows no progression to atrophy or metaplasia I need to take a break from antibiotics as they are wreaking havoc on my body, and also will get blood test to see if I have devolved to full-blown anemia.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Mon Nov 25, 2019 11:38 am
by Helico_expert
hmm... seems like you have tried almost everything.
Amoxicillin
Metronidazole
Clarithromycin
Levofloxacin
Tetracycline
Rifabutin

the only one you have not tried is furazolidone.

You heard of Talicia?
perhaps you want to give that a try?
https://www.redhillbio.com/RedHill/Temp ... &IID=13236

alternatively, you can just buy the pills separately to save some money.
the combination of talicia is
omeprazole 150mg TID (alternative is to use rabeprazole 20mg TID, better)
amoxicillin 1g TID
rifabutin 150mg TID

it might work for you because it has large dose of PPI. you can probably boost this treatment with bismuth 220mg QID too.

blood test is not useful
cagA and vacA testing are also not useful
histology is good.
if the laboratory can do bacterial culture, that would be ideal.

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Tue Nov 26, 2019 12:30 am
by ankiwo72
Helico_expert wrote:
Mon Nov 25, 2019 11:38 am
the only one you have not tried is furazolidone.
Unfortunately furazolidone is not available in USA. It is no longer FDA-approved due to cancer concerns so not available to prescription here: https://en.wikipedia.org/wiki/Furazolidone
"Since furazolidone is a nitrofuran antibiotic, its use in food animals is currently prohibited by the FDA under the Animal Medicinal Drug Use Clarification Act, 1994.[5]

Furazolidone is no longer available in the US."
Helico_expert wrote:
Mon Nov 25, 2019 11:38 am
You heard of Talicia?
perhaps you want to give that a try?
https://www.redhillbio.com/RedHill/Temp ... &IID=13236
Talicia is not available yet in the US but should be in the first quarter of 2020. But I already did 14-day rifabutin/amoxicillin/omeprazole combination (actually switched mid-treatment to pantaprazole) back in March and it failed so I'm not sure how it would work better next time. Plus each time I go on amoxicillin I have to go through desensitization procedure and my allergist is adamant I shouldn't go through that again, or at least not for a while. I have been through the procedure 3x in the past year for 3 different H. Pylori treatments to include amoxicillin and it is very hard on my system.
Helico_expert wrote:
Mon Nov 25, 2019 11:38 am
it might work for you because it has large dose of PPI. you can probably boost this treatment with bismuth 220mg QID too.
Every treatment over the past year has had PPI 20mg/3x day except for last treatment which was 40mg/3x day PPI with high dose amoxicillin 3000mg/day, still didn't work
Helico_expert wrote:
Mon Nov 25, 2019 11:38 am
blood test is not useful
cagA and vacA testing are also not useful
histology is good.
if the laboratory can do bacterial culture, that would be ideal.
Yes, we are going to do susceptibility testing again. The last sensitivity test showed most drugs were going to be ineffective except amoxicillin. After a few of those treatments I don't know if amoxicillin will even be as effective now.
Previously:
Amoxicillin: <=0.008
Ciprofloxacin: >2
Clarithroymycin: >0.5 Resistant
Metronidazole: 32
Tetracycline: 1

For past year over 4 separate blood tests, my ferritin has gone down and is now low at 10. My iron saturation is borderline low at 15. Strangely enough, my serum iron level is within normal range. I am constantly fatigued and things hurt all over my body.
My hemoglobin, hematrocrit, MCH levels have all been steadily decreasing, and my RDW level has been increasing and is now high at 16.1
I had read somewhere that high RDW with H. Pylori has some correlation to intestinal metaplasia. My last endoscopy only showed chronic gastritis due to H. Pylori. Do you have any information on that correlation? Is there any validity to it?
Last year I had numerous wacky blood test results: high gastrin, high Chronic Uriticaria index, very high CGA (without PPI use--leading my GP to think I had carcinoid which thankfully turned out not to be), very high N-methylhistamine levels. Not sure if these are related to H. Pylori infection.
I suppose the endoscopy result will answer my question, but the waiting on the results is going to be torture!
Please let me know if there is anything that stands out to you that might be related?
Thanks!

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Tue Nov 26, 2019 3:49 am
by NoxArcana
ankiwo72 wrote:
Tue Nov 26, 2019 12:30 am
For past year over 4 separate blood tests, my ferritin has gone down and is now low at 10. My iron saturation is borderline low at 15. Strangely enough, my serum iron level is within normal range. I am constantly fatigued and things hurt all over my body.
My hemoglobin, hematrocrit, MCH levels have all been steadily decreasing, and my RDW level has been increasing and is now high at 16.1!
I had problems with fatigue, my doctor thought in iron deficiency too, but told me to test vitamin b12 and folic acid, iron levels and b12 were normal, but folic acid was extremely low, did you tested folic acid before?

Re: Upcoming H.Pylori treatment #7 - question on serum ferritin and sensitivity testing

Posted: Tue Nov 26, 2019 9:45 am
by Helico_expert
Every treatment over the past year has had PPI 20mg/3x day except for last treatment which was 40mg/3x day PPI with high dose amoxicillin 3000mg/day, still didn't work
and which PPI was that? 20mg omeprazole is probably equal to 10mg of rabeprazole.

Ciprofloxacin: >2
Clarithroymycin: >0.5 Resistant
Metronidazole: 32
Tetracycline: 1
You've got the most resistant strain I have ever encountered.
But your Metronidazole resistance is not too bad. Have you tried Rabeprazole + Bismuth + Tetracycline + Metronidazole combination?

high RDW with H. Pylori has some correlation to intestinal metaplasia
i have not come across articles that state correlation between RDW and intestinal metaplasia. But I think if it is significant, it would be mentioned in the treatment consensus as a marker.