What Bismuth compounds are effective to treat H.Pylori?

[Harish Andela]

Hello. I have failed two rounds of treatment to eradicate h.pylori.

The regimens I used are:

First Round:
amoxicillin, clarithromycin and pantoprazole for 14 days.

Second Round:
amoxicillin, levofloxacin and esomeprazole for 14 days.

I was advised here to take a quadruple therapy containing Bismuth salts. I want to know what Bismuth compounds are most effective for treatment.
Here in India Bismuth compounds are not readily available but I did find two varieties of bismuth products a company is manufacturing.

1) Bismuth subsalicylate and
2) Tri Potassium Dicitrato Bismuthate.

Are there other bismuth compounds that I should look for? Can you suggest what you have normally found to be efficacious in the treatment?

Also, the current quadruple regimen I am thinking of is - Amoxicillin, PPI, Bismuth compound, Antibiotic-2. To sum it up, my questions are these:

1) What Bismuth compound should I use and what is the dosage per day?
2) Is it okay to use Amoxicillin again since I have also used it in the first two regimens which failed?
3) What are my options for the second antibiotic since I have already used Clarithromycin and Levofloxacin in my first two rounds?
4) Is there an alternate regimen I should try first before the quadruple regimen?

Thank you. Regards.
H.

[Hexrain]

Helio_Expert will disagree most likely, but from my reading you need to treat get your whole family that lives with you checked out and treated if positive, make sure you have good mouth hygiene (get a teeth cleaning to remove plaque), and use some supplemental natural remedies like probiotics and raw garlic. Give yourself the best chance of elimination. I can't speak to the resistance to antibiotics. Certainly Helio_Expert can help you there.

[Helico_expert]

I am sorry i am not familiar with those two bismuth compound. you'll have to read the manufacturer's instruction in taking them.

but your strategy is right.
PPI + Bismuth + Amoxicillin + Antibiotic-2

Since you have taken Clarithromycin and Levofloxacin, you cant take those two again.

so you need to talk to your doctor.
1. metronidazole
2. tetracycline
3. rifabutin
4. furazolidone

the side effects of those drugs increase in that order. however, everyone react differently to those antibiotics.
in addition, metronidazole is quite commonly used for dental or parasite infection. So, you think you had it before, you can skip it.

[Harish Andela]

can you tell me what is the suggested dosage of bismuth per day?

I am getting medication where each tablet has 120mg of Bismuth. How many mg should I take per day and should I take it before or after eating food?

[Helico_expert]

i am sorry, like you said, there are too many bismuth compound on the market. it is better you read the manufacturer instruction or best, seek your local doctor's opinion.

[Atrix]

Besides antibiotics (tetracycline, metronidazole) my 14-days eradication regimen that turned out successful included 4 x 120 mg bismuth subcitrate (DeNol) daily, eventhough my doc prescribed only 2 x 120 mg. You can go even up to 8 x 120 mg. I read research on the net that bismuth subcitrate yielded slightly better results than PeptoBismol / bismuth subsalicylate. Best of luck!

[Harish Andela]

Thanks for the info.
So you took tetracycline and metronidazole with Bismuth? Normally one of the antibiotics is amoxicillin.
How do you take Denol? After food? And do you swallow it or is it chewable tablet?

[Atrix]

Yes, PPI + metronidazole + tetracycline + bismuth compound = a standard quadruple therapy. For me this was second or even third-line therapy. Apart from PPIs I took all pills together, both on empty stomach e.g. in the morning after getting up and after meals. No chewing, just swallowed the stuff. Thanks God, it worked.

[cyprian zimunya]

How long should i wait to get a breath test while on ppi....does h pylori develop a resistant against tetracycline

[Helico_expert]

When you are on PPI, you cannot do breath test.

you'll have to stop PPI and antibiotics for at least 2 weeks.

There are some reports about H. pylori resistant to tetracycline, but it's very rare. at least we have not seen it in our clinic yet.