Resistant H Pylori - 4th Treatment

[HPgirl]

Thank you for the invitation to post my question. I am so grateful to you for your work in this area.
I’m a mother of 2 young children, who’s been battling H Pylori for well over 5 years. My major symptom aside from discomfort, is fatigue as I cannot seem to keep my ferritin up while this is in my body. My symptoms are getting worse after every treatment.

My history is that my grandfather died with bleeding ulcers at the age of 39. For years, I travelled the world with my job. I have always been very careful with eating and drinking while abroad. My husband and son were tested for HP and were negative.

I’ve had 4 rounds of antibiotic treatment to date (2 triple therapies 10 & 14 days and 2 quadruple therapies both 14 days) with various antibiotics. My family and I thank you for any information you may be able to share and any hope you may have for me!

This is my medical history/treatment (most recent to 1st diagnosis):
June 2011 Urea breath test positive

April 2011 4th Treatment: Quadruple therapy 14 days
TECTA 40MG EC TABLET, METRONIDAZOLE 500MG CAPSULE, TETRACYCLINE 250MG CAPSULE,BISMUTH
Feb 2011 Endoscopy – confirmed HP still present, looks like Celiac however blood tests are negative

Dec 2010 H Pylori urea breath test positive
3rd Treatment: Quadruple therapy 14 days
APO-CLARITHROMYCIN 250MG TABLET, APO-OMEPRAZOLE 20MG DR CAPSULE, METRONIDAZOLE 250MG TABLET, BISMUTH

Sept 2010 H Pylori urea breath test positive
2nd Treatment: Triple therapy 14 days
APO-CLARITHROMYCIN, AMOXICILLIN, LANSOPRAZOLE
August 2010 Very low iron & B12 Treatment: Iron injections (6-7)
Nov08-July09 Pregnancy & Delivery
Oct 2008 Relocated to another province, symptoms return, low iron, put on GI specialist wait list

August 2008 Gastro symptoms (with chest pain), H Pylori urea breath test positive
1st Treatment: Triple therapy 10 days
APO-CLARITHROMYCIN, AMOXICILLIN,OMEPRAZOLE

[Helico_expert]

Thank you for your interesting story.

let us know how is your breath test result one month after your 4th treatment.

[HPgirl]

June 2011 Urea breath test was positive after 4th treatment.
(it's the first note under treatment, a bit buried in my long post - sorry!)

[HPgirl]

I'm booked in for another scope in 2 days. We are going to test for antibiotic sensitivities. Dr. Marshall, I read your post about checking PH level...is there anything else that might be helpful to check while this procedure is being done? Thank you.

[HPgirl]

My specialist is suggesting another round of therapy. A shot in the dark again as apparently we cannot do the antibodies sensitivity test in my city. 3 biopsies were taken and showed h pylori in each. A 5th round of treatment is being suggested. It's called a sequential therapy - 5 days one antibiotic and 5 days another. I'm not confident that this will help as I've had these same antibiotics before and it was not eradicated. Has anyone had experience with sequential therapy? At wits end here, energy incredibly low (affecting iron, b12). Thanks in advance for any suggestions.

[Helico_expert]

5th therapy with the same antibiotic... i doubt that will work too.
the antibiotic resistance must have already built up. it has nothing to do with which city you are from now. since they have got your biopsy, why not just ask for antibiotic sensitivity test? that will proof them you're the first one with very resistant H. pylori in your city.

[HPgirl]

@ Helico_expert - The sequential therapy is a therapy with one difference - one of the antibiotics is changed from clarithromycin to metronidazole after day 5 of the 10 day treatment (taken with amox the whole treatment and a PPI x2/day). I'm wondering if there are any others who have tried this with any success?

[Helico_expert]

sorry, I missed this thread. But yes, people have tried sequential therapy and reported success.

by the way, let me summarize your treatment.

August 2008
CLARITHROMYCIN, AMOXICILLIN,OMEPRAZOLE

Sept 2010
CLARITHROMYCIN, AMOXICILLIN, LANSOPRAZOLE

Dec 2010
CLARITHROMYCIN, METRONIDAZOLE, OMEPRAZOLE, BISMUTH

April 2011
TECTA, METRONIDAZOLE, TETRACYCLINE, BISMUTH

Jul 2011
Amox + Clarithromycin (5 days) +PPI then
Amox + metronidazole (5 days) + PPI

I am surprised that your 4th treatment didnt work.
you really got very nasty bug.
i dont think your sequential treatment will work as you bug most probably already resistant to both clarithromycin and metronidazole.
however, let's see how amoxycillin works. 10 days of Amox continuously with PPI has been reported success before.
if it fails again, i'll ask Prof. Marshall to have a look.

[HPgirl]

UREA came back positive after 5th treatment Helico Expert. Do you think Prof Marshall could have a look as you suggested above? I would very much appreciate it. Thanks for your help.

[barjammar]

At Helico_expert's suggestion I scanned through the questions and answers. By now you are resistant to metronidazole and clarithromycin. You could still be sensitive to a few of our special treatments however.
I think the failures are due to inadequate acid blockade.
Depending on where you are in world, we could send you a special treatment package to your doctor if you can bring him/her on board with the whole process. The drugs would be expensive unless your health care system covered them and you could acquire them from where you are.
I won't say anything further because I don't want you going off half cocked and using half a treatment, then making it more difficult for yourself later.
If I receive a communication from your doctor I will proceed. It is likely your would need a four drug combo, with two special antibiotics in the mix, given for at least 10 days.
Your doctor can fax a referral to my UWA office in three weeks when I will be back from a long trip. +61893464816 I don't charge anything, the referral is to make sure you have a medical person looking after the treatment for you, in case you have a reaction or something.
In the meantime, just take the esomeprazole to keep yourself comfortable. Also, fax us your biopsy results if you have them. Be patient! We have much more difficult cases than you at the H.pylori research laboratory.