Dr. Marshall, do you agree with this?

[loft]

Dear Dr. Marshall,

I'm sorry for bothering you, but I'm currently living in Portugal and don't have access to an English-speaking doctor.

I'll try to be brief, as I'm sure you're busy. After an endoscopy and biopsy in Feb I was diagnosed with HP. On Feb 26 I started a 2 week course of Clarithromycin 500mg 2x day, Omerprazole 40mg 2x day, and Amocicillin 500mg 2x day. I completed the course on March 12. Things were great until two days before the course ended. The stomach pain and diarrhea come back.

Since then, I have started taking probiotic suppliments Optibac http://www.optibacprobiotics.co.uk/shop ... sp?catid=6 and Align http://www.aligngi.com/ to replace an good bacteria lost from the antibiotics. I also started eating AB yogurt as a Japanese study found it eliminates the symptoms (but not the bacteria) of HP after 6 weeks.

From about March 20 to March 26, I felt totally great. Now, again the pain is back. I'm continuing the probiotics, but I went to a Portuguese doctor yesterday who prescribed a 14 day course of Clarithromycin 250mg 2x day, Omerprazole 20mg 2x day, and Metronidazole 400mg 2x day.

Since he didn't speak English well at all (and I don't speak Portuguese) I was wondering if you would agree with his prescriptions. I'm pretty sure I conveyed I had HP and the first meds didn't work. If you notice, he has still kept me on Clarithromycin and replaced Amocicillin with Metronidazole.

I haven't has a HP breath test to confirm if it's still there and I probably won't get the opportunity to have one until I return to the States in September. Being an expert do you think I should go ahead with this regiment of meds without getting a breath test? Also, should I add Pepto-Bismol to it?

Thanks so much for taking the time to read this. I look forward to your advice.

Best,
Michael

[barjammar]

Good question. I recommend have a breath test before trying again with more antibiotics - you might not need them.
In Portugal, the doctors are pretty expert with treating H.pylori so I can't really question the treatment. The cure rate will be related to the amoxicillin only because the bug will be resistant to clarithromycin by now. But sometimes the combinations still work - not scientific but true! If you can take extra PPI then quadruple the omeprazole dose to 80 mg per day as it strengthens the amoxicillin effect. Take it for 10 days rather than seven.