Helicobacter Forums

I have tried three rounds of treatment now and the last RUT test was still positive.
The treatments I have tried are:
First round: PPI+ Clarithromycin+ Amoxicillin - 14 days
Second round: PPI+ Clarithromycin+ Amoxicillin again for 14 days
Third round - PPI+ Levofloxacin+ Amoxicillin for 14 days

Now I want to opt for quadruple therapy.
I understand it is PPI+ Antibiotic 1+ Antibiotic 2+ Bismuth product

My questions are:

1) What is the suggested dose of PPI per day? And how long before the meal should it be taken?
2) What are the two antibiotics you suggest along with dosage per day?
3) Can I still take amoxicillin as one of the antibiotics? or is it better to change to a different one?
4) What Bismuth compound is most effective? Or are they all the same?
5) What is the suggested dosage of Bismuth per day and how should I take it? Should I take it before food or after? And how many times a day should I take it? Also, are Bismuth pills to be swallowed or should it be allowed to dissolve in the mouth like some coated pills.

The bismuth question is pretty stupid, but I ask because none of the doctors I met with have ever prescribed it and it is not even available in the regular drug stores here. I have to try and get it from a company which only makes to export it to other countries. So as Plato said- better safe than sorry.


Also, I'm thinking of using only Bismuth for a couple of days and then starting the antibiotics. My logic is the bismuth would kill the antibiotic bacteria in sufficient numbers in two days that it would give the antibiotics an edge when I start taking them. I want to do this because I'm running out of antibiotics to take. What do you think of this strategy?

Thank you for your time helico expert.
How come you are the only one who answers all the questions on this forum. Are you multiple people?

1. we normally prescribe double the standard dose of PPI. we like rabeprazole as it has longer effective life in the body. we normally prescribe 20mg x3 a day

2. you can try tetracycline and metronidazole + bismuth and PPI

3. You can continue Amoxicillin with furazolidone if you want. It's very hard for H. pylori to become resistant to these two antibiotics.

4. Good question. we dont know which is the best bismuth. we have not done proper comparison. You just get whatever bismuth compound is available in your country and follow the manufacturer's instruction.

your idea of taking bismuth first is smart. It's known as the sequential therapy. it'll work.

Thanks you.
Couple of follow up questions.
1) What is the dosage of Bismuth per day? And should I swallow the Bismuth pills or let them dissolve in the mouth?
2) Is Amoxicillin with Furazolidone two separate antibiotics or just one tablet in combination?
3) what are the dosages of Tetracycline and Metronidazole per day?
4) if I use amoxicillin, what should amoxicillin replace? Tetracycline or Metronidazole?

1, bismuth dosage, please refer to the manufacturer's instruction.

2. Amoxicillin and Furazolidone are two different antibiotics.

3. Tetracycline 500 mg (4 times a day); Metronidazole 400 mg (3 times a day)

4. Not sure what you meant. But, I think you can try either A or B

A. PBTM
PPI + bismuth + tetracycline + metronidazole

B. PBAF
PPI + bismuth + Amoxicillin + furazolidone

fingers crossed this one works. donno what to do if it wont

you can always come back to share your experience. we will try our best to guide you.