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What to do After Second line treatment failure (quadruple therapy) ?

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united2
Posts: 8
Joined: Sun Aug 19, 2018 7:34 am

What to do After Second line treatment failure (quadruple therapy) ?

Post by united2 »

Hi
after a big stomach pain, I have been diagnosed with ulcer and gastritis and was positive for H pylori after biopsy
My first treatment was amoxicillin, metronidazole and ppi for 10 days, and after this treatment I was still feeling sick, and after a second biopsy still positive with H pylori

The second treatment was amoxicillin metronidazole clarythromicin and ppi for 10 days, and still was feeling sick after that, so a did a third biopsy and was positive for H pylory and also severe gastritis

My symptoms are: Constant Bloating and burping, vomiting, nausea, indigestion and also Weight loss, I feel that those symptoms get worse when I am on antibiotics as I don't tolerate the side effects specially metronidazole

So I want your opinion before I see my doctor, what treatment should I take after this? what antibiotics should i take ? and is this a normal case because I start to feel really bad about this. also want to stop ppi that I have been taking daily for 5 months
Thanks!

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Helico_expert »

Since H. pylori cannot become resistant to Amoxicillin, you can always repeat it. same to bismuth (pepto-bismol).

so, your next treatment will be PPI + bismuth + Amoxicillin + an antibiotic that you have not tried (eg. ciprofloxacin).

this time, try ask your doctor for higher dose of PPI and amoxicillin. In Prof. Marshall's clinic, he uses Rabeprazole (PPI), 20mg, 3 times a day; and Amoxicillin, 1g, 3 times a day.

Roland
Posts: 10
Joined: Thu Aug 16, 2018 3:09 pm

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Roland »

Does this treatment last for 14 days as well?
I also see that there is one antibiotic in higher dose Amox 1gx3

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Helico_expert »

Prof Marshall usually prescribe for 10 days. But 14 days is fine too.

HelicopterPylaros
Posts: 23
Joined: Wed Jul 25, 2018 2:18 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by HelicopterPylaros »

Helico_expert wrote:
Sun Aug 19, 2018 11:27 pm
Since H. pylori cannot become resistant to Amoxicillin, you can always repeat it. same to bismuth (pepto-bismol).
Just out of curiosity: What is the reason, that Helicobacter Pylori can’t be resistant to Amoxicillin?

united2
Posts: 8
Joined: Sun Aug 19, 2018 7:34 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by united2 »

Helico_expert wrote:
Sun Aug 19, 2018 11:27 pm
so, your next treatment will be PPI + bismuth + Amoxicillin + an antibiotic that you have not tried (eg. ciprofloxacin).

this time, try ask your doctor for higher dose of PPI and amoxicillin. In Prof. Marshall's clinic, he uses Rabeprazole (PPI), 20mg, 3 times a day; and Amoxicillin, 1g, 3 times a day.
So can i take Pylera with amoxiline and ppi ? scince there is no 'bismuth only' medication or pylera + ppi will do ?

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Helico_expert »

HelicopterPylaros wrote:
Tue Aug 21, 2018 1:45 pm
Helico_expert wrote:
Sun Aug 19, 2018 11:27 pm
Since H. pylori cannot become resistant to Amoxicillin, you can always repeat it. same to bismuth (pepto-bismol).
Just out of curiosity: What is the reason, that Helicobacter Pylori can’t be resistant to Amoxicillin?
Good question. nobody knows. perhaps amoxicillin is targeting a very important protein that H. pylori cannot afford to mutate. I think the more interesting question is, since H. pylori can never become resistant to Amoxicillin, why cant it be killed by amoxicillin alone? again, there is no answer for this. PPI + Amoxicillin was shown to have a cure rate of only 50%. It was shown that with an extra antibiotic (Clarithromycin or metronidazole), the cure rate is able to boost up to 80-90% (in old days).

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Helico_expert »

united2 wrote:
Wed Sep 26, 2018 5:39 am
Helico_expert wrote:
Sun Aug 19, 2018 11:27 pm
so, your next treatment will be PPI + bismuth + Amoxicillin + an antibiotic that you have not tried (eg. ciprofloxacin).

this time, try ask your doctor for higher dose of PPI and amoxicillin. In Prof. Marshall's clinic, he uses Rabeprazole (PPI), 20mg, 3 times a day; and Amoxicillin, 1g, 3 times a day.
So can i take Pylera with amoxiline and ppi ? scince there is no 'bismuth only' medication or pylera + ppi will do ?
Pylera contains PPI + Bismuth + tetracycline + metronidazole. so there is no need for additional PPI or Amoxicillin. It's already a very strong treatment.

united2
Posts: 8
Joined: Sun Aug 19, 2018 7:34 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by united2 »

Thanks for the response
But i am not sure that pylera contains PPI ,at least in the french pills (im in that region) , also searched on the net , it says that pylera should be combined with ppi but it dose not contain PPI , can you confirm ?

Helico_expert
Site Admin
Posts: 4600
Joined: Wed Mar 02, 2011 7:20 am

Re: What to do After Second line treatment failure (quadruple therapy) ?

Post by Helico_expert »

your doctor would have also prescribed you the PPI together with the Pylera. You need to take two types of pills. the PPI once or twice a day and the Pylera pill 4 times a day.

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