Question about Bismuth based treatment is this dosage right?

Whereas amoxicillin, clarithromycin and an acid pump blocker make up the most widely used treatment, people who are allergic to penicillin, or who have failed treatment, require other antibiotics. Bismuth compounds (Pepto-Bismol or De-Nol) with can be used in various combinations with other antibiotics such as tetracycline, metronidazole, furazolidone, ciprofloxacin etc., especially when other therapy fails.

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LeandroSalvatore
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Re: Question about Bismuth based treatment is this dosage right?

Post by LeandroSalvatore » Sun Oct 08, 2017 7:49 pm

Hello Helico_expert! Thanks for your reply!

I meant that I took everything, including PPI (Omeprazole) with food. While I was supposed to take bismuth and the PPI some time before food.

Yes, I've also been reading that H pylori doesn't become resistant to Bismuth and Amoxicillin. Thank you!

But I have some uncertainty about taking Doxycycline. There are some studies that claim Doxycycline to be very ineffective and inferior to Tetracycline.
https://www.ncbi.nlm.nih.gov/pubmed/1589705
In this study back from 1992 the autrhor claims that Doxycycline based treatment had only 65% success rate, whereas Tetracycline based regiment was successful in 92% of the patients.

https://www.ncbi.nlm.nih.gov/pubmed/26849820
But in this meta-analysis from 2016 the author claims that Doxycycline is about as effective as Tetracycline, with Odds Ration of 0.95

Do you think I should go ahead with Doxycycline? In the country where I live, there's only Russian-made Tetracycline available. I have serious reservations about the quality of that Tetracycline. But there's German-made and Austrian-made Doxycycline available.

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Re: Question about Bismuth based treatment is this dosage right?

Post by Helico_expert » Mon Oct 09, 2017 5:17 am

Doxycycline and Tetracycline are the same family. Doxycycline is the newer version of Tetracycline, probably less side effect. However, Tetracycline seems to be better. We have not tested Doxycycline ourselves, but our patients who were prescribed with Tetracycline have very high cure rate. Perhaps you should consider Tetracycline over Doxycycline.

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Re: Question about Bismuth based treatment is this dosage right?

Post by LeandroSalvatore » Mon Oct 09, 2017 9:59 pm

I have to take into account that I've already taken Tetracycline previously in that botched Quadruple therapy. And, as I said, where I live there's only Russian made Tetracycline available.
So, I'm leaning towards Doxycycline. I'm very hesitant at this stage, having gone through 3 courses of h pylori eradication. I want to get it right this time and not mess it up. The doctors here are hopeless - when I went to see a gastroenterologist, she prescribed a very expensive medicine that contained Bismuth and a PPI but she didn't prescribe an antibiotic. She probably gets a cut from the sales of that drug. Another gastroenterologist just said that there's no need to eradicate h pylori and that it's harmless. So, I don't have anyone to ask for advice, just reding stuff online.
And I'm a bit confused by the confliciting information about Doxycycline efficacy.

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Re: Question about Bismuth based treatment is this dosage right?

Post by Helico_expert » Tue Oct 10, 2017 12:14 am

how about rifabutin? it's probably harder to get as it is controlled drug reserved for tuberculosis. but we use it for very resistant H. pylori.

Rabeprazole + Bismuth + Amox + Rifa

LeandroSalvatore
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Re: Question about Bismuth based treatment is this dosage right?

Post by LeandroSalvatore » Thu Oct 12, 2017 12:42 pm

Helico_expert wrote:
Tue Oct 10, 2017 12:14 am
how about rifabutin? it's probably harder to get as it is controlled drug reserved for tuberculosis. but we use it for very resistant H. pylori.

Rabeprazole + Bismuth + Amox + Rifa
Hi! Thanks for that! I'll read up on rifabutin
I can't log in from my phone for some reason, so I can only reply from a desktop which I don't always have at hand.
I wish I had access to databases such as Scopus to read all the available research papers on this subject

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