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I am going to 2nd treatment next week.

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canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: I am going to 2nd treatment next week.

Post by canadianhelico » Wed Jun 27, 2018 8:13 am

does it mean the chance of getting rid of h pylori with IPP + cloryth + AMOX + bismuth for 7 days is almost impossible?

Helico_expert
Site Admin
Posts: 2414
Joined: Wed Mar 02, 2011 7:20 am

Re: I am going to 2nd treatment next week.

Post by Helico_expert » Wed Jun 27, 2018 9:31 am

it's a good treatment. In australia, PPI, Amox and Clari still have about 80% cure rate. With bismuth will be even higher. But the cure rate of this treatment will be poorer in Europe countries. Last time I heard, Clari resistance is too common in European countries.

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: I am going to 2nd treatment next week.

Post by canadianhelico » Wed Jun 27, 2018 9:39 am

I am in Canada....and as mentioned in an earlier post:

Because of increasing failure of therapy, the consensus group strongly recommends that all H pylori eradication regimens now be given for 14 days. Recommended first-line strategies include concomitant nonbismuth quadruple therapy (proton pump inhibitor [PPI] + amoxicillin + metronidazole + clarithromycin [PAMC]) and traditional bismuth quadruple therapy (PPI + bismuth + metronidazole + tetracycline [PBMT]). triple therapy (PPI + clarithromycin + either amoxicillin or metronidazole) is restricted to areas with known low clarithromycin resistance or high eradication success with these regimens.Recommended rescue therapies include PBMT and levofloxacin-containing therapy (PPI + amoxicillin + levofloxacin). Rifabutin regimens should be restricted to patients who have failed to respond to at least 3 prior options.

seriously, I am so nervous and overwhelmed by all this. I am leaving in less than 3 weeks for 2 months in South America....and I pray GOD I have a good vacation. I need this after my father's death and my wife leaving me last year.

Helico_expert
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Joined: Wed Mar 02, 2011 7:20 am

Re: I am going to 2nd treatment next week.

Post by Helico_expert » Wed Jun 27, 2018 9:45 am

I think all these information may be too much for you. You need to be positive. If it fails, there is always another treatment. The treatment process can be long, but it's worth it.

alternatively, if you can find a doctor, who has access to good laboratory that can culture H. pylori, then a specific test can be done to find out exactly what antibiotics are useful. We have been culturing H. pylori from the most difficult cases in Western Australia. and by following the laboratory result, we have a cure rate of over 90%.

canadianhelico
Posts: 18
Joined: Fri Jun 22, 2018 12:49 am

Re: I am going to 2nd treatment next week.

Post by canadianhelico » Wed Jun 27, 2018 10:00 am

Helico_expert wrote:
Wed Jun 27, 2018 9:45 am
I think all these information may be too much for you. You need to be positive. If it fails, there is always another treatment. The treatment process can be long, but it's worth it.

alternatively, if you can find a doctor, who has access to good laboratory that can culture H. pylori, then a specific test can be done to find out exactly what antibiotics are useful. We have been culturing H. pylori from the most difficult cases in Western Australia. and by following the laboratory result, we have a cure rate of over 90%.
Hi,

from another study:

One hundred and twenty-four cases of H. pylori gastritis were examined from medical centers in four different geographic regions of the USA. The overall prevalence of clarithromycin resistance was 32.3 % (range 23.1-45.8 %). There was no significant difference in the prevalence of clarithromycin resistance by study site, gender, age, or race/ethnicity. In a subset of 67 patients that had clinical follow-up data, the overall prevalence of clarithromycin resistance was 31.3 %. There was a 2.9-fold increase (p = 0.002) in treatment failure for cases with clarithromycin resistance (57.1 %) compared to wildtype H. pylori (19.6 %).
CONCLUSIONS:

H. pylori clarithromycin resistance in the USA exceeds the estimated 20 % prevalence compatible with successful empiric antibiotic therapy. This resistance resulted in a significant rate of treatment failure in all sites surveyed. Empiric therapy in the USA should be used with caution until there is better regional or local determination of H. pylori antibiotic resistance.


and from another one: Antibiotic resistance rates to 4 most common used antibiotics in different continental areas.
Image

In conclusion, the highest clarithromycin resistant area was North America, and this study showed a slight increasing tendency of clarithromycin resistance of H. pylori in the world. Since clarithromycin is the most potent antimicrobial agent involved in the standard treatment protocol as well as the resistance rates were still at the low level, where clarithromycin-containing triple therapies could be used empirically.

If I had no trip coming up, I wouldn't be so stressed out about it. I just want to have a good time over there, to be able to eat local foods, drinks, etc. I still have all the meds for the PPI + bismuth + metronidazole + tetracycline [PBMT] therapy. Should I start it tommorow?? would it be too much for my stomach? The pharmacist told me I can't eat dairy with these meds. No sun also. No alcohol.

what happens with the 10% that can't be cured by antibiotics ?

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

Re: I am going to 2nd treatment next week.

Post by Helico_expert » Wed Jun 27, 2018 11:23 am

what happens with the 10% that can't be cured by antibiotics ?
I assume you meant the 10% from our patients.
Although we have a 90% cure rate, the rest of the 10% is due to side effects and gave up treatment. We believe that if we try harder, the HP can be eradicated. However, because most of these patients from the 10% are senior citizen; in addition, their gastric symptom is quite mild (no ulcer, no metaplasia, and no cancer). So we think the chance of them becoming worse is very unlikely.

back to your literature search, because the resistance rate of Clari is only 30%. I think you still have high chance of getting rid of it.

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