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Quadruple Therapy

The cure of Hp usually requires antibiotics. Other things have been tried and have a weaker effect.

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Gcs1903
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Quadruple Therapy

Post by Gcs1903 » Fri Aug 03, 2012 9:21 am

Hi,

Can anyone offer any advice about Quadruple Therapy and the side effects. I was diagnosed with HP last year and was treated with a triple combination of Clarythromycin/Omeoprazole and Metrinazadole. This seemed to alleviate the symptoms.

However, around May I started suffering stomach pain as if I was constantly hungry. I was retested and found to be positive for HP. A second course as above was prescribed. At the end of the course I suffered from food poisoning. About a month later I contracted gastric flu. A third HP test came back positive. After querying matters at my doctors, I have been put on a quadruple course involving Metrinazadole/Bismuth/Tetracycline and Lanzaprole. I am allergic to penicillin so my options are limited I understand.

I started the treatment a week ago and immediately I felt an improvement. However, around day 5 I felt nausea, day 6 brought slack bowel movements and on day 7 I have a persistent gnawing pain in my upper abdomen. This is almost like I feel hungry all the time but food doesn't ease it. I should also say that this is the feeling I had before the treatment began.

Are these symptoms common during quadruple therapy? I have read that the side effects can be horrendous and I am willing to persevere but I would have thought I would feel a bit better by now and not worse? I realise my stomach has been through a lot with the HP, the gastric flu and the food poisoning but nonetheless it is a worry, especially with the relationship between HP and cancer.

Any shared input will be gratefully revived.

Helico_expert
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Re: Quadruple Therapy

Post by Helico_expert » Sat Aug 04, 2012 6:18 am

the side effects that you are having is common. you'll probably notice your stool being very dark too. that is because of bismuth. after all, you already completed 7 days treatment. make sure you finish the whole treatment. 10 days? or 14 days?

keep us update your progress.

Gcs1903
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Re: Quadruple Therapy

Post by Gcs1903 » Sat Aug 04, 2012 10:44 am

Thanks for the reply. I am on a 14 day course and I am determined to finish it despite the debilitating pain in my upper abdomen. I also have the dark stools as you rightfully pointed out. A lower abdominal pain is also bothering me just above my pelvis. This too started just before treatment. I guess HP symptoms are wide ranging once it gets on top of you.

Do you have any idea how long these symptoms usually last should treatment be succesful? I have been told by my GP that I will be getting referred for an endoscopy soon after the course if the symptoms don't ease.

Helico_expert
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Re: Quadruple Therapy

Post by Helico_expert » Sat Aug 04, 2012 11:29 pm

10 days treatment is usually enough. 14 days treatment is just to make sure it really kill the bugs. If your side effect is really bad, stop at least after 10 days. Side effects usually stop after you stop your treatment. during the recovery, just eat plenty of fruits and water. After antibiotic treatment, you can have some probiotics to replenish the good bacteria in your guts. At least prevent the bad bacteria to dominate the stomach, which may already happened (usually that's the reason for the side effects in the bowel).

Atrix
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Re: Quadruple Therapy

Post by Atrix » Sat Dec 30, 2017 10:30 am

First, many thanks for creating and maintaining this forum! Great knowledge and experience accumulated here. Thanks to people for sharing their suffering and stories and to @helico_expert, in particular, for invaluable advice. Now, my 2 cents. I'm 44 years old, relatively fit male from Latvia, Baltics. My first encounter with H Pylori took place 10 years ago, when I started waking up at 3 - 4 am with a gnawing hunger feeling / stomach pain which went away after I snacked a bit, for instance, an apple. An endoscopy was done which foung the bug. Was given a standard triple therapy, if I am not mistaken, that lasted for 7 days. I remember that symptoms persisted for a month after treatment letting me think that maybe it didn't work, but then subsided and I could live my life on. I didn't do a follow-up test. For next 10 years everything was normal again. Could eat and drink as before.
This June, when I had finished a 5 year stint of a verryyyy stressful job, which involved a lot of travel, including to many developing countries and currently working in a one, I had several bouts of mild diarrhea, which I initially wrote off as some indigestion. When loose stool story repeated accomanied by stomack pain I thought it might be food poisoning or a stomach virus. Then bloating started. I was belching and passing wind constantly and my tummy felt heavy like a had a stone in it. Went to see gastroenterologist. Blood tests came back ok, in general. The HP blood test was not done, because I had already this bug before. Stool tests found traces of ascaris parasite worm, but no increase in HP antigen, which meant I was negative. The Doc prescribed a PPI Pantoprazole for 2 weeks and when they passed my symptoms were back.
I insisted on having an endoscopy which found erosive gastroduodenitis and HP positivity by quick urease test. Then I did a mistake. An acquaintance suggested another doctor, who allegadly was a good specialist. He put me for 10 days on bismuth subcitrate (De-Nol) - 120 mg tablet 2x daily, Ranitadine 150 mg 2x followed by 7 days of a macrolide antibiotic Spiramycine 3000 mg 2x daily (used for mouth and teeth infections) and Pantoprazole. When I confronted him with the current treatment recommnedations, he replied that practically everybody in this country was HP positive, it would be useless to erradicate it, just needed to suppress the HP bacteria overgrowth and symptoms. I decided to give it a try, which was false. I also resorted to natural / alternative remedies as supportive treatmen. Drank gallons of green, spearmint and chamomille tea. Ingested olive and flaxseed oil on empty stomack. Ate lot of garlic and took high doses of Vitamin C, D, A and fish-oil. Turmeric powder with black pepper and organic honey (not Manuka one). To put it short, after Spiramycine and natural remedies I felt 50-70 % better, but slight bloating remained and, to my surprise, a new sensation popped up, which I didn't have before, namely, chest burn. I also got a fungal infection Athlete's foot despite antifungal medicine prescribed for the duration of Spiramycine. I decided to do a post-treatment breath test, which is not available in the country I presently work in. I went to my homeland and the breath-test came with a DOB value 6,2 which is close to borderline, but still positive. HPylori was suppressed to a great extent, but not eradicated.
Since my grandfahter died young of stomach cancer I decided to not take chances and finish the job. At that point I had read practically every scientific paper available on the net concerning different treatment methods, efficacy of various antibiotic treatment protocols etc. I knew I wanted to go for the bismuth quadruple therapy for 14 days. I went to the gastroenetrologist whom I visited first and told my story. He shared my approach and said that there was no way around antibiotics cocktail and the latest treatment recommendations called Maastricht 5 consensus report also point to bismuth quadruple therapy for 14 days. Since Pylera is not available (and in my opionion, a way toooo expensive), I got prescribed: PPI Pantoprazole 40 mg x 2 daily (I regret no to have asked for a higher dose), bismuth subcitrate / De-Nol 120 mg x 4 (I arbitrarily doubled the dose to 240 mg x 4, since I read that increasing on bismuth would give better eradication rates), tetracycline 500 mg x4, metrodinazole 500 mg x3 plus probiotics with Lacto / Bifido strains and an anti-fungal Flucanozol pills on days 3,6,9,12. Total cost of medicines, including PPIs and probiotics, roughly, 60 Euro. All in all, nearly 300 tablets in 2 weeks, or around 24 pills daily. To my mind, this stuff is pure poison. But I was determined to go with this to bitter end. Jumping off the treatment was not an option, because it would make things even worse and I think it was worth it. Had some side effects though. A funny, sourly taste in the mouth during the whole treatment, light nausea around 6th till 10th day, dry rough skin, especially on hands. Itchy eylides, allergic dermatitis probably. Stool was black but I knew it was harmless because of bismuth compounds. So, today is my second day since I finished treatment. I was and am mentally ready to deal with post-treatment issues, having pain and stomach troubles after the treatment. However, aside from light discomfort and some chest burning that I attribute to acid rebound I am quite ok. Time will show how successful the whole treatment was. I intend to do a breath-test in 2-3 months to confirm the eradication. So, this is my story, folks. I wouldn't waste my time and money on snakeoil-type of remedies, but go for the treatment recommended by modern science. I also decided to do changes in my lifestyle. Quit coffee, cigars, hot peppers, will go more easy on alcohol and trying to manage better my stress.
Good luck and health to everyone. Will post again after having post-treatment breath-test results. Yeah, one more thing. It seems that HP is somehow related to skin diseases.. Some years ago, I've got a disease called lichen ruber planus. When I started HP eradication lesions flared up.. I don't know, if there is a connection though. Yes, and, in my opinion, there is still lack of clarity about transmission mechanism of HP, so I can only guess, if my second HP tour is a re-infection or previous HP was not cleared up.. All the best and Happy New Year!

Helico_expert
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Re: Quadruple Therapy

Post by Helico_expert » Sat Dec 30, 2017 12:35 pm

Great story and superb intel.

first of all, i think your current quadruple therapy is very strong. It has very high success rate.

if you still have reflux symptoms, you can continue PPI or ranitidine to control the symptoms (protect your throat being burnt).

i think it's a great idea that you'll do a follow up breath test 2 - 3 months later.

in my opinion, there i no need to quit coffee, hot pepper. But it's totally up to you. if quitting them made your stomach better, by all mean and go for it.

is HP related to skin disease? this has been a long debate. My believe is no, because HP only stays in the stomach and not the skin. The skin disease is most probably caused by some unknown bacteria and by chance, killed by the antibiotics used on HP.

Although the transmission is not proven, my bet is on oral hygiene. If you take good care of your oral hygiene, then you have less chance of spreading to your family and friends. like wise, if everyone under the same roof maintain a good oral hygiene, then I believe the chance of spreading will be close zero.

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