Failed two therapies...what next??

[gaurav2301]

Hi,

I have been suffering from H Pylori since quite some time now with symptoms that have grown worst in the last 6 months or so. My symptoms are more like bouts of stomach ache and then continuous vomiting for the night. My symptoms usually start in the evening and persist through the night and usually settle by the morning leaving me completely exhausted. These episodes happen randomly once a fortnight ( or sometimes more frequently) and I haven't been able to relate it to any particular foods causing this yet.

I have undergone two triple therapies so far -
First - Amoxycillin (500 mg *3) +Omeprazole (20mg*2)+ Metrodinazole(500mg *2 ) for 7 days
Symptoms reappeared and H Pylori confirmed by endoscopy.

Second - Amoxycillin (500 mg *3) +Omeprazole (20mg*2)+ Clarithromycin(500mg *2 ) for 7 days
Again symtoms re-appeared and H Pylori confirmed by endoscopy.

During second endoscopy, biopsy was performed and samples were collected for culture. However, my gastroenterologist just called and informed that antibiotic susceptibility testing could not be performed as cultures could not be prepared out of the samples but he confirmed presence of the bacteria.

I am now looking for a third empirical treatment, most probably for a longer duration than 7 days. I think bacteria might have levofloxacin resistance so I would like to ignore that. Would appreciate any suggestions for third line rescue therapy that have been proven effective. ( Quadraple ??)

Thanks in advance.

[Helico_expert]

You might want to discuss with your doctor about our quadruple therapy. We have a good cure rate of over 90% among the patients who has H. pylori resistant to Clarithromycin and Metronidazole.

PARC and PBRC

http://onlinelibrary.wiley.com/doi/10.1 ... 359.f03t03

http://onlinelibrary.wiley.com/store/10 ... 4ca1d1eb37

[gaurav2301]

Thank you for your prompt response.

One more question - Isn't Ciprofloxacin from the same family as Levofloxacin and Ofloxacin? If I have resistance to these, should I not go CIP free??
Also, Is it fine to use pepto bismol instead of Denol?

Regards,

[newhpyloridiag]

Also you can try Pylera 10 day regimen. It is a bit expensive but effective.

[Helico_expert]

Yes, CIP is same as Levo and other quinolones. You may discuss with your doctor to substitute CIP with other antibiotics such as Tetracycline or furazolidone.

[gaurav2301]

Also you can try Pylera 10 day regimen. It is a bit expensive but effective.

The reason I am a bit sceptical about pylera is that my first regimen was metrodinazole bases which didn't work...I think I have resistance to it. Although I have heard higher doses of metrodinazole may be able to overcome resistance, don't want to risk it again.

Helico expert- furadolizone seems to be an alternative but is there any risk involved in it? Or any special dietery requirement if I add it to my therapy??

[Helico_expert]

any drugs come with risk. Furazolidone is actually banned in Europe for being carcinogen. But, Metronidazole was too a carcinogen and yet has been widely used. Anyway, you should discuss with your doctor about the risks.