Amoxcillin and Tetracycline cant be combined

[Ltb]

Hi
Ive just been given quadruple therapy with Amoxcillin, Tetracycline, Bismuth and Lanzoprazole. Im hoping that after 2 failed treatments I will finally rid myself of this awful bug. However Ive been reading about the ineffective combination of Amox and Tetra:

http://www.ncbi.nlm.nih.gov/pubmed/11966868

I hope this is not true as I took along your in house treatment plan and the doctor prescribed this after seeing it recommended on your plan. Could an expert comment on this and whether this is true?

[Helico_expert]

It is a combination in desperate situation. It has a low cure rate and we would only prescribe this when there is no other alternatives. your doctor should try the PARC or PBRC regimen, which is our first line treatment.

The reason this is not the best combination is because amoxicillin inhibit cell wall synthesis and the active growing bacteria will grow without a cell wall. Hence lead to death.

Tetracycline on the other hand is a protein synthesis inhibitor. Bacteria cannot produce the building block for cell division and eventually get killed by host immune system or the acidic environment.

When you mix them together, the cell is not growing and hence cannot be killed by amoxicillin.

The above is a theory anyway. there has been mix data published by other groups. a more recent article suggests that amoxicillin and tetracycline combination still produce high cure rate.

http://www.wjgnet.com/esps/ArticleInPre ... x?id=12044

[Ltb]

hi thanks for clearing this up. I had no idea that your recommended chart worked this way. I took it to the doctor and I thought they were all equally efficient combinations to get rid of h pylori. I wish I had gone with the Cipro/Rifabutin combination now rather than Tetracyline and Amox and Bismuth.

I am currently on day 5 of 14, and see no improvements in my indigestion. Do you think I should
a) finish the course and see what happens or
b) contact my doctor to switch to the first line therapy ?

Out of interest what are the cure rates like for Tetracycline/Amoxcilin/Bismuth? If it is low are we talking 30%? 50% or 70%?

I guess I just don't want to be pointlessly taking antibiotics if there is such low chance of success especially if I have to take another load of them in a few months.

Thanks so much for getting back to me, I really appreciate it....and sorry I keep messaging on here. Its just been such a long road and a horrible 2 years Im now desperate to get rid of this!

[Helico_expert]

Our clinical data showed about 50% cure rate.


however, some other studies showed a much lower cure rate of around 20-30%
http://www.ncbi.nlm.nih.gov/pubmed/11966868
http://www.ncbi.nlm.nih.gov/pubmed/16928222


but since you already started, please continue and finish the treatment. Stopping it half way only increase the chance of resistance.

[Ltb]

hello
thanks for this. I will finish the course and get re tested. how long should I leave it before I do another quadruple therapy though if im positive? is it bad to do the cipro/bismuth/amox/rifabutin so soon after this treatment?

[Helico_expert]

normally we ask patients to wait 4 weeks before the second test.

however, if you really need some acid reducing drug to help you through, you can follow this guideline.
http://www.helico.com/PYtest_guide_2013.pdf