Treatment after first line treatment failure

[MIshMIsh]

Hello experts,

I took the first line treatment after breath test came positive- 25.
My doctor prescribe me the following:

1. Metronidazole 250 * 3 a day
2. Amoxicillin 500* 4 a day (twice morning twice evening)
3. Omepadex 20 once a day.
All for 10 days.

I took another breath text and it came 54...

1. Can you advice me for a recommended second line treatment?
2. The high value of H.P have a meaning? reason its came higher then the first test and after antibiotic? it doesn't make sense.
3. There is a relation between higher value and eradication rate?

I'm really really appreciate your help, thanks!

[Helico_expert]

If you had not tried clarithromycin, then you can ask your doctor for the following

rabeprazole 20mg 3 times a day
amoxicillin 1g 3 times a day
clarithromycin 500mg 2 times a day

we prefer rabeprazole because we believe it works better than omeprazole
also the dose of rabeprazole is double the standard dose as it increases the cure rate

amoxicillin is given in very high dose as well. it's a very safe antibiotic and H. pylori cannot become resistant to it. So it's ok to take higher dose.

you can also ask for bismuth 220mg 4 times a day to prevent C. diff complication.

[MIshMIsh]

Dear Helico_expert,

Thank you for the answer!

Do you have, from you experience, any insight about the values of the UBT test?

Thanks again.

[Helico_expert]

there are so many brands of breath test. So i cannot tell you how to interpret the DPM value.

in Australia, UBT value below 50 is negative, above 200 is positive. between 50-200 is in-determinant.
the higher the UBT value, means higher accuracy.
although the value is positively correlate with the bacteria mass, it has no clinical significance. We have seen patients with over 3000 DPM, but only normal gastritis. in contrast, we have seen patients with 205 DPM having ulcer. So, all you need to know from breath test is positive or negative. You can interpret the value as the accuracy of the test.